Clinical and Programmatic Aspects of Kidney and Liver Failure and Its Impact on Tuberculosis

Palmero D.; Mendoza A. · Essential Tuberculosis (2021) · DOI: 10.1007/978-3-030-66703-0_30

Resumen

People with chronic renal failure (CRF) are at higher risk for infection and death from tuberculosis (TB), related to both increased host susceptibility from the cellular immunodepressive effects of CRF and social determinants of health among persons with CRF. The diagnosis of latent TB infection (LTBI) and active TB disease is challenging due to the atypical clinical presentations of TB in patients with CRF, triggering delays in diagnosis and treatment. Further, patients with CRF/TB are less likely to be included in clinical trials and observational research, resulting in limited guidelines on the diagnosis and treatment of TB and LTBI in this population. Treatment of LTBI and active TB is also challenging in patients with CRF due differences in drug metabolism and drug interactions. Tuberculosis frequency is increased 14-fold in patients with chronic liver diseases (CLD) and liver cirrhosis, especially in advanced decompensated disease and in men >65 years old, associated to an immune dysfunction syndrome. Treatment of TB associated to CLD is challenging; depending on the severity of the liver impairment, can be used regimens that includes two, one or none potentially hepatotoxic drugs. These regimens have less effectiveness than the standard regimen. The co-morbid conditions of TB/CRF and TB/CLD have a potential programmatic impact in the TB incidence and mortality and need a high suspicion level in Nephrologists and Hepatologists, not familiarized with TB. This chapter includes two conditions in which tuberculosis incidence is boosted, such as kidney and liver failure, and comprise two separate sections, one for each topic. © Springer Nature Switzerland AG 2021.