Are we Treating or Curing Tuberculosis? Profile of Secondary Renal Amyloidosis in Patients Receiving Anti Tubercular Treatment

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Abstract

Introduction. Secondary renal amyloidosis due to tuberculosis is a debilitating disease with considerable mortality and morbidity due to renal failure and other manifestations of both amyloidosis and renal failure. Most patients with amyloidosis have been adequately treated with DOTS (Directly observed treatment, Short Course strategy). The aimof our study was to analyze the epidemiological and demographic profile of patients undergoing renal biopsy and found to have renal amyloidosis secondary to tuberculosis.

Methods. In this study, retrospective renal biopsy data was collected from 2009-2012 and patients with amyloidosis were identified and their clinical and biochemical parameters were analyzed.

Results. Incidence of amyloidosis was 4.66% (n=24/514) among total renal biopsies. Among this, secondary amyloidosis constituted 87.5% of total amyloidosis. The commonest etiology in these patients was pulmonary tuberculosis (73.5%). All patients with tuberculosis had previously received DOTS treatment. 47.5% of patients with amyloidosis had renal impairment and 10.5% developed end-stage renal disease over 12 months and were dialysis dependent.

Conclusions. Amyloidosis due to tuberculosis is a well-established, yet under-diagnosed complication of tuberculosis. The duration and treatment status of tuberculosis does not influence the occurrence of amyloidosis, as most of the patients were treated appropriately with DOTS. There are no predictive factors in patients who will develop secondary amyloidosis. At present there is no specific treatment apart from supportive therapy. The prognosis is poor, as most of these patients inexorably progress towards end-stage renal disease (ESRD) with significant mortality and morbidity. To conclude, at present we are only treating tuberculosis, we are yet to cure tuberculosis.

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