慢性透析患者における結核症の検討

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Among 135 cases of chronic renal insufficiency receiving regular hemodialysis at the Hospital of the Institute of Medical Science, Tokyo University, during the recent 10 years, 5 patients developed active tuberculosis. Out of these cases, four cases which are reported in this paper were diagnosed pathologically after the autopsy.<BR>Two cases were miliary tuberculosis. One of them is a 38-year-old woman who was diagnosed as pleurisy with effusion and has been treated with INH and KM for one and half months immdiately before starting the hemodialysis. Another case is a 31-year-old male who had tuber culoma in the right apex of the lung before the induction of hemodialysis. These two cases complained abdominal pain, fatigue and anorexia, and sometimes fever, pleural effusion and leucocytosis after the induction of hemodialysis, but these symptoms were regarded as the uremic -ones.<BR>The third case had active pulmonary tuberculosis and the fourth had tuberculous axillar adenitis. It is suggested that the outbreak rate of tuberculosis is higher among patients receiving hemodialysis, and the differential diagnosis between tuberculosis and uremia is very often difficult because of the similarity in the clinical signs and symptoms.<BR>The mechanism of higher risk of developing tuberculosis among patients receiving hemodi alysis could be explained by the impaired cellular immunological response of the host. For patients undergoing hemodialysis, it is important to investigate in detail their past history of tuberculosis and to perform regularly the chest X-ray examinations and the PPD skin testing. In case if these patients show continuous fever of unknown origin or had past history of tuberculosis, it is necessary to apply prophylactic measures such as the use of anti-tuberculous drugs and the taking of nutritious foods.
日本結核病学会の論文

慢性透析患者における結核症の検討

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