Chronic kidney disease, immunosuppression and

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January 2011 / Vol 21 / Issue 1. Letters to Editor ... Nelson Textbook of Pediatrics. 17th ed. Philadelphia: WB. Saunders; 2008. p.958-78. Access this article ...

[Downloaded free from http://www.indianjnephrol.org on Wednesday, September 28, 2016, IP: 200.121.220.130] Letters to Editor confounding role of intravenous iron therapy. Indian J Nephrol 2010;20:125-31. 2. Finkelstein FO, Juergensen P, Wang S, Santacroce S, Levine M, Kotanko P, et al. Hemoglobin and plasma vitamin c levels in patients on peritoneal dialysis. Perit Dial Int 2011;31:74-9. 3. Nair KM, Iyengar V. Iron content, bioavailability and factors affecting iron status of Indians. Indian J Med Res 2009;130: 634-45. 4. Jacobs C. Iron metabolism pre and post the erythropoietin era. Nephrol Ther 2006;5:S313-20. Access this article online Quick Response Code:

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in leukocyte function following exposure to dialysis membranes increase the susceptibility of dialysis patients to TB.[2] Reaction size limits for determining a positive tuberculin test result vary with the individual's risk of infection. Those with highest risk of having infection progress to disease – either having diseases associated with immunosuppression or on immunosuppressive therapy – a reactive area ≥ 5 mm is classified as positive result.[3] The authors have considered induration of 10 mm or more as positive for the diagnosis of latent TB (LTB) in their study. I feel that if the cut-off for tuberculin positivity was taken as 5 mm, the number of cases diagnosed as LTB would have definitely increased.

DOI:

S. A. Zaki

10.4103/0971-4065.78087

Department of Pediatrics, Lokmanya Tilak Municipal General Hospital, Mumbai, India

Chronic kidney disease, immunosuppression and tuberculin test sensitivity Sir, I read with interest the recent report on “Tuberculin skin test for the diagnosis of latent tuberculosis during renal replacement therapy in an endemic area: A single center study” by Agarwal et al.,[1] and have the following comments to offer. Host resistance to infection is primarily mediated by cellular immunity which is deficient in patients with chronic kidney disease (CKD). The occurrence of infections including tuberculosis (TB) is therefore high in such patients. In addition, various studies have reported the incidence of TB in patients with CKD and on maintenance hemodialysis to be 6–16 times that of general populations.[1,2] Impaired cellular immunity suppresses the mitogenic response of lymphocytes. Protein malnutrition, zinc and pyridoxine deficiency, and defects

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January 2011 / Vol 21 / Issue 1

Address for correspondence: Dr. Syed Ahmed Zaki, Room No. 509, New RMO Quarters, Sion, Mumbai – 400 022, India E-mail: [email protected]

References 1. Malhotra KK. Treatment of tuberculosis in chronic renal failure, maintenance dialysis and renal transplant. Indian J Nephrol 2003;13:69-71. 2. Malik GH, Al-Mohaya SA, Al-Harbi AS, Kechrid M, Azhari O, Shetia S, et al. Spectrum of tuberculosis in dialysis patients in Saudi Arabia. Saudi J Kidney Dis Transpl 2003;14:145-52. 3. Munoz FM, Starke JR. Tuberculosis (Mycobacterium tuberculosis). In: Behrman RE, Kliegman RM, Jenson HB, Stanton FB, editors. Nelson Textbook of Pediatrics. 17th ed. Philadelphia: WB Saunders; 2008. p.958-78. Access this article online Quick Response Code:

Website: www.indianjnephrol.org

DOI: 10.4103/0971-4065.78088

Indian Journal of Nephrology