Acquired Bartter Like Syndrome in a Patient of Multi Drug Resistant Pulmonary Tuberculosis Secondary to Kanamycin Nephrotoxicity – A Case Report

Abstract

India has the highest estimated burden of tuberculosis infection (TBI) globally caused by mycobacterial tuberculosis, with nearly 35-40 crores Indian population having TBI, of which 26 lakhs people (18-36 lakh) are estimated to develop Tuberculosis (TB) disease annually. An integrated and comprehensive ‘cascade of care’ approach and new advances in national tuberculosis elimination program have provided us with definitive management of tuberculosis infection and an active tuberculosis disease. Aminoglycosides are one of the cornerstones of drug resistant tuberculosis. Highly effective yet are very notorious for their dose dependent and independent nephrotoxicity. Our experience denotes a rare diagnosis of acquired Bartter like syndrome, in a 60-year man with pulmonary tuberculosis who received Kanamycin for a period of 5 months and subsequently presented with life threatening electrolyte imbalance. It also highlights the importance of adherence to the standard guidelines under National Tuberculosis Elimination Program (NTEP) and the importance of the routine monitoring of electrolytes in Multi-Drug Resistant Tuberculosis (MDR-TB) patients receiving treatment that includes Kanamycin.