Extrapulmonary Tubercular Lesions Accompanied by Pulmonary Tuberculosis in Dialysis Patients

Abstract

Extrapulmonary tubercular lesions generally result from extention or dissemination from a pulmonary infection. Immunodeficiency is assumed to predispose uremic patients to dissemination. In order to elucidate the characteristics of extrapulmonary lesions accompanied by pulmonary tuberculosis in uremic patients, I made an epidemiological study.
The subjects were 4722 males and 2552 females receiving chronic dialysis in 161 institutions. Patients with pulmonary tuberculosis were 59 males and 26 females among 84 male tuberculars and 53 female tuberculars on dialysis. Fourteen males and thirteen females have pulmonary tuberculosis accompanied by extrapulmonary lesions. Dialysis patients with pulmonary tuberculosis accompanied extrapulmonary lesions more frequently than patients in non-uremic stage. Pulmonary tuberculosis with extrapulmonary lesions showed worse prognosis than that without extrapulmonary lesions. Fatality became higher along with the increment of the number of organs tuberculously involved. Pulmonary tuberculosis in dialysis patients was accompanied by tubercular lesions in almost all extrapulmonary organs except brain and muscle. Frequency of involvement differed from organ to organ. The fatality of the patients was low, when frequently involved organs suffered. On the other hand, the fatality became high, when infrequently involved organs suffered. The fatality of the patients was almost reversely correlated with the frequency of organ involvement. Extrapulmonary organs which showed high fatality were observed among dialysis patients but were not observed among non-uremic patients.