Teaching Point (Section Editor: W. Herrington) Imported bugs, not beasts: extensively drug-resistant tuberculosis and acute kidney injury

the rates of TB have remained at a more consistent level in the UK over recent years; however, the incidence of TB in the UK remains high (13.9 per 100 000 population) in comparison to most other Western European Countries. The proportion of multi-drug-resistant (MDR-TB) cases is stable at 1.6 % with two cases of extensively drug-resistant tuberculosis (XDR-TB) reported in 2012 [1]. How-ever, worldwide, 10 % of MDR-TB cases are XDR-TB [2]. XDR-TB is defined as resistance in vitro to isoniazid, rifampi-cin, any fluoroquinolone and at least one of three injectable second-line drugs (amikacin, kanamycin or capreomycin) used to treat TB. Treatment with at least five drugs to which the organism is susceptible is recommended [3, 4]. Treat-ment of XDR-TB is only successful in 40 % [5]. The incidence of drug-resistant TB is higher in patients who have had pre-vious TB treatment and in individuals born outside of the UK [1]. The treatment for TB continues to be a balance of benefit and risk to the patient and the wider population and is outlined in Table 1. Inadequate treatment leads to an in-creased risk of further resistance and increases morbidity and mortality. XDR-TB is best treated with six agents in the intensive phase (6–9 months) and then four agents during the continuation phase (21–25 months) [5]. Regimes for anti-TB therapies are guided by local microbiology advice, based on sensitivities and there is still considerable toxicity from current TB therapy, especially agents used to treat XDR-TB. We present a case of acute kidney injury (AKI) second-ary to capreomycin toxicity in a young female receiving treatment for XDR-TB