ASPECTS OF PULMONARY TUBERCULOSIS VERIFICATION IN THOSE AT THE TERMINAL STAGE OF CHRONIC KIDNEY DISEASE

The objective of the study: to investigate the efficiency of three-level algorithm for differential diagnostics of respiratory tuberculosis in those at the terminal stage of chronic kidney disease, verifying the diagnosis by etiologic and morphologic methods.

Subjects and methods. A three-level algorithm was used in 34 patients at the terminal stage of chronic kidney disease in order to verify respiratory disorders detected by X-ray examination. If it was impossible to verify the diagnosis on Level I, invasive methods were added to the examination: bronchoscopy with biopsy, punctures on Level II and surgical interventions (VATS resections) on Level III. Detection of tuberculosis mycobacteria or their DNA was a diagnostic criterion.

Results. Three-level algorithm assured 100% diagnostics in 34 patients at the terminal stage of chronic kidney disease (95% CI 89.6-100). On Level I, diagnosis was verified in 13/34 (38.2%; 95% CI 23.9-55.0) patients, examinations of Level II had to be used in 21/34 (61.8% 95% CI45.0-76.1) patients, which allowed defining the diagnosis in 15/21 (71.4%; 95%CI 50.0-86.2) patients. Examinations of Level III were needed in 6/34 (17.7%; 95% CI 8.4-33.5) patients, and diagnosis was verified in all of 6/6 (100%; 95% CI 61.0-100).

Among diseases detected in 34 patients at the terminal stage of chronic kidney disease, respiratory tuberculosis prevailed – in 19 (55.9%; 95% CI 39.5-71.1) patients; the majority of tuberculosis patients – 9/19 (47.4%; 95% CI 27.3-68.3) was detected on Level II of examination, including 2 patients with bronchial tuberculosis. On Level I, non-specific pulmonary diseases were detected in the majority of patients – 8/15 (53.3%; 95%CI ДИ 30.1-75.2).

Microbiological diagnostics of tuberculosis was effective when examining the following specimens: sputum (Level I) in 5/19 (26.3%; 95% CI 11.8-48.8) patients, biopsy specimens (Level II) – in 9/14 (64.3%; 95% CI 38.8-83.7) patients; surgical specimens (Level III) – 5/5 (100%; 95% CI 56.6-100). When using three level diagnostic algorithm, the following tests were success: fluorescent microscopy – in 7/19 (36.8%; 95% CI 19.2-59.0) cases; culture on liquid media in Bactec MGIT 960 – in 17/19 (89.5%; 95% CI 68.6-97.1) cases, realtime PCR – in 19/19 (100%; 95% CI 83.2-100) cases. Multiple/extensive drug resistance was detected in 11/17 (64.7%; 95% CI 41.3-82.7) patients (the part of XDR made 11.8%).

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