Abstract
Background
Tuberculosis is a major public health concern and is mostly associated with systemic complications, like renal impairment. Tuberculosis patients with reduced renal function experience unfavorable outcomes of tuberculosis treatment. In Ethiopia, there are limited studies on glomerular filtration rate. Therefore, early assessment and identification of factors associated with abnormal glomerular filtration rate are paramount for the prevention of renal dysfunction and proper management.
Objective
To determine the magnitude of abnormal glomerular filtration rate in patients with tuberculosis before the initiation of anti-tuberculosis therapy.
Methods
A facility-based cross-sectional study was conducted from July 1 to November 1, 2025. All newly diagnosed adult tuberculosis patients were included from each hospital. Glomerular filtration was determined using the 2021 chronic kidney disease-epidemiology creatinine level equation, and if it is less than 60 mL/min, it is described as a reduced glomerular filtration rate. Descriptive data were reported using frequency tables, graphs, and pie charts. Binary logistic regression analysis with a p-value of < 0.25 was used to select candidates for the multiple logistic regression analysis. Finally, multiple logistic regression analyses were carried out, and a P-value <0.05 were considered as statistically significant.
Results
In this study, 7.99% (23/288) with a 95% confidence interval of 5.13%–11.74% were tuberculosis patients with abnormal glomerular filtration rate. The magnitude of abnormal glomerular filtration rate among tuberculosis patients with anemia was 10.4%. Factors associated with abnormal glomerular filtration rate among patients with tuberculosis before anti-tuberculosis therapy were nausea (AOR=3.4; 1.01–11.1) and cough (AOR=3.3; 1.2–9.2).
Conclusion
Abnormal glomerular filtration was higher in patients with tuberculosis and anemia. Anemia can result in a reduction in the glomerular filtration rate due to vasoconstriction of the renal artery, which shifts blood flow to vital organs. Therefore, the renal glomeruli become hypoxic, and their function reduced. Nausea and cough were factors associated with abnormal glomerular filtration rate prior to anti-tuberculosis initiation among tuberculosis patients.
Keywords: tuberculosis, glomerular filtration rate, bale, oromia, Ethiopia
Introduction
Globally, approximately 10.7 million people suffer from tuberculosis (TB) and 1.23 million die of the disease. A high burden of tuberculosis is reported in low-and middle-income countries.1 Ethiopia is also considered among the countries with a high burden of tuberculosis. The risk of developing tuberculosis is higher among patients with chronic kidney diseases and results in renal function impairment.2–4 In chronic kidney disease, the risk of developing tuberculosis is approximately 4.5 times that of the general population, and the prevalence and mortality rate are also higher.5,6 This is due to an immune deficiency resulting from a decline in renal function.7 Impaired immunity in reduced glomerular function rates delay treatment response and increases mortality.8,9
Tuberculosis primarily affects the lungs. It also affects other organs, including the kidneys. It can affect the kidneys either directly or indirectly through immune-mediated and inflammatory mechanisms.10 Kidney-involved tuberculosis can manifest as glomerulonephritis and impair kidney function.11 Malnutrition, illness, dehydration, and inflammation increase the risk of renal dysfunction among patients with TB and reduce the primary function of the kidney.2
Glomerular filtration rate helps in early identification of kidney dysfunction. A reduction in glomerular filtration rate has clinical implications. It is associated with anemia and vitamin D deficiency in patients.12–17
Baseline glomerular filtration is important in patients with tuberculosis. Dose correction is paramount in cases of impaired renal function.18,19 Kidney dysfunction may occur before anti-tuberculosis therapy in patients with TB. However, there is limited data on the magnitude of reduced glomerular filtration among newly diagnosed tuberculosis patients.20
Renal function test abnormalities among patients with tuberculosis are severe complications and can interrupt anti-tuberculosis treatment therapy due to kidney damage.21 First-line anti-TB medication can lead to acute kidney injury.22 Ethambutol and isoniazid anti-tuberculosis drugs are associated with acute kidney injury.23
Acute kidney injury can occur suddenly within 7 days and globally, approximately two million people die of acute kidney injury every year. Some patients with acute kidney injury are at an increased risk of developing chronic kidney disease (CKD).24 Reduction of glomerular filtration rate below 60 mL/min over a period with the presence of proteinuria is chronic kidney disease.25 Reduction of glomerular filtration below 60 mL/min within a single creatinine level is reduced glomerular filtration rate and its limitation is it can be temporary and affected by dehydration and acute kidney injury.26 Approximately 27% acute kidney injury patients will develop permanent kidney injury.27
Determining the magnitude of the glomerular filtration rate among patients with tuberculosis before the initiation of anti-tuberculosis therapy is crucial for the early identification of renal impairment and for optimizing treatment decisions. No study has been conducted on glomerular filtration rate and its associated factors prior to anti-tuberculosis treatment in Ethiopia. Therefore, this study aimed to assess the magnitude of abnormal glomerular filtration rate and identify factors associated with abnormal glomerular filtration rate among tuberculosis patients before anti-tuberculosis therapy at Bale Zone hospitals in Southeast Ethiopia.
Methods
Study Area
This study was conducted in the Bale Zone. The Bale Zone is located in the Oromia Region to the southeast of Ethiopia. Its capital city is Robe, and it is approximately 430 km from the capital city of Ethiopia (Addis Ababa). The total population of the Bale Zone is 1,217,435. There are four Hospitals in Bale Zone. Goba Hospital, Robe Hospital, Goro Hospital, and Delo Mena Hospital and all the four hospitals included in the study.
Study Design and Period
A facility-based cross-sectional study was used, and the data were collected from July 1 to November 1, 2025.
Sample Size Determination
There was no similar study conducted to calculate the sample size in our setup. Therefore, we included all new tuberculosis patients, either confirmed bacteriologically or clinically supported radiologically who attended at four Bale Zone hospitals from July 1 to November 1, 2025. Accordingly, 288 patients with the tuberculosis were participated in this study.
Source Population
All newly diagnosed adult tuberculosis attending at Bale Zone Hospitals were the source population.
Study Population
All newly diagnosed adult tuberculosis attending during the study period at Bale Zone Hospitals were the study population.
Inclusion Criteria
Newly diagnosed adult tuberculosis patients and willing to participate were the inclusion criteria.
Exclusion Criteria
Critically ill tuberculosis patients, tuberculosis with severe mental illness were excluded.
Operational Definitions
Reduced Glomerular Filtration Rate
It is when the estimated glomerular filtration rate reduced below 60 mL/min.26
Anemia
It is when the hemoglobin level is less than 13 g/dl for males and less than 12 g/dl for women.28
Data Collection Procedure
Structured questionnaires developed after reviewing the related literature29,30 and lab formats were used to collect data. The questionnaire has socio-demographic factors, clinical factors, behavioral factors, and lab formats. Trained nurses and medical laboratory technologists served as the data collectors. Laboratory analyses were performed using 4 mL of blood. Creatinine determination was done using Cobas C301 automated clinical analyzer chemistry by the enzymatic method. Then glomerular filtration rate was calculated using creatinine level, sex, age, body mass index as input for the CKD-EPI formula.
Data Quality Assurance
The questionnaires were translated into local languages (Afan Oromo and Amharic). They were then re-translated into English for consistency. A pre-test was conducted on 5% of the total sample size at Ginnir Hospital, and the time allocation for each study participant was modified accordingly. The total sample size was estimated from the previous four months’ records of the hospitals. Data collected daily were checked by the principal investigator. Standard operating procedures and manufacturer instructions were used to control the quality of laboratory results.
Data Management and Analysis
The collected data were checked and exported from the Kobo toolbox to SPSS v. 20. Descriptive analyses were presented using tables, graphs, and pie chart. Analytical analysis was carried out using both binary and multiple logistic regression analyses. Assumptions were checked using the Hosmer–Lemeshow test. Candidates were selected for multiple logistic regression analysis with P-values <0.25 in binary logistic regression analysis. Multi-collinearity was assessed using the variance inflation factor. Accordingly, the variance inflation factor was <10, and the tolerance was >0.1. Finally, predictor variables with a P-value <0.05, as determined by multiple logistic regression analysis, were considered statistically significant.
Results
Sociodemographic Characteristics of the Study Participants
In this study, 288 patients with tuberculosis were participated. Accordingly, the majority, 155 (53.8%) of the study participants were in the age category of 18–30 with a mean age of 31±10.7 years (Table 1).
Table 1.
Socio-Demographic Characteristics of Study Participants Among Tuberculosis Patients at Bale Zone Hospitals, Southeast Ethiopia, 2026
| Variables | Category | Frequency (%) |
|---|---|---|
| Age | 18-30 | 155 (53.8%) |
| 31-40 | 80 (27.8%) | |
| 41-50 | 38 (13.2%) | |
| >50 | 15 (5.2%) | |
| Sex | Male | 149 (51.7%) |
| Female | 139 (48.3%) | |
| Residence | Urban | 102 (35.4%) |
| Rural | 186 (64.6%) | |
| Marital status | Single | 49 (17%) |
| Married | 223 (77.4%) | |
| Divorced | 16 (5.6%) | |
| Occupation | Government worker | 9 (3.1%) |
| No- government worker | 12 (4.2%) | |
| Merchant | 19 (6.6%) | |
| Student | 35 (12.2%) | |
| Housewife | 75 (26%) | |
| Daily worker | 138 (47.9%) | |
| Religion | Muslim | 186 (64.6%) |
| Orthodox | 71 (24.7%) | |
| Protestant | 31 (10.8%) | |
| Educational status | Informal education | 11 (3.8%) |
| Formal education | 277 (96.2%) |
Magnitude of Abnormal Glomerular Filtration Rate
Estimated glomerular filtration rate was determined using the 2021 CKD-EPI creatinine equation. Hence, the magnitude of abnormal glomerular filtration was 7.99%, with a 95% confidence interval (CI) of 5.13–11.74% (Figure 1).
Figure 1.
Magnitude of abnormal glomerular filtration rate among tuberculosis patients before anti-tuberculosis initiation at Bale Zone Hospitals, Southeast Ethiopia, 2026.
Clinical Characteristics of Study Participants
Tuberculosis patients presented with different signs and symptoms. Patients presenting with cough were 130 (45.1%) and tuberculosis with anemia was 106 (36.8%) (Table 2). In tuberculosis patients with anemia, the magnitude of abnormal glomerular filtration rate was 10.4% (Figure 2).
Table 2.
Clinical Characteristics of Study Participants on Study Conducted Among Tuberculosis Patients at Bale Zone Hospitals, Southeast Ethiopia, 2026
| Variables | Response | Frequency (%) |
|---|---|---|
| Diabetes mellitus | Yes | 25 (8.7%) |
| No | 263 (91.3%) | |
| Hypertension | Yes | 26 (9%) |
| No | 262 (91%) | |
| Anemia | Yes | 106 (36.8) |
| No | 182 (63.2%) | |
| Comorbidity | Yes | 53 (18.4%) |
| No | 235 (81.6%) | |
| Body mass index | < 18.5 kg/m2 | 123 (42.7%) |
| 18.5–24. 9 kg/m2 | 148 (51.4%) | |
| 25-29. 9 kg/m2 | 17 (5.9%) | |
| Cough | Yes | 130 (45.1%) |
| No | 158 (54.9%) | |
| Night sweating | Yes | 101 (35.1%) |
| No | 187 (64.9%) | |
| Nausea | Yes | 119 (41.3%) |
| No | 169 (58.7%) | |
| Anorexia | Yes | 113 (39.2%) |
| No | 175 (60.8%) | |
| Fever | Yes | 89 (30.9%) |
| No | 189 (65.6%) | |
| Chest pain | Yes | 108 (37.5%) |
| No | 180 (62.5%) |
Figure 2.
Magnitude of abnormal glomerular filtration among tuberculosis with anemia on study conducted before anti-tuberculosis initiation among tuberculosis patients at Bale Zone Hospitals, Southeast Ethiopia, 2026.
The magnitude of abnormal glomerular filtration differed between patients with pulmonary and extrapulmonary tuberculosis. Accordingly, the magnitude of abnormal glomerular filtration was 8.6% in extra extrapulmonary tuberculosis patients (Figure 3).
Figure 3.
Magnitude of abnormal glomerular filtration rate among type of tuberculosis before anti-tuberculosis initiation at Bale Zone Hospitals, Southeast Ethiopia, 2026.
Behavioral Characteristics of Study Participants
Patients with tuberculosis had a different history of behavioral factors. In this study, 20.8% of patients had a history of chat chewing (Figure 4).
Figure 4.
Behavioral factors on study conducted before anti-tuberculosis initiation among tuberculosis patients at Bale Zone Hospitals, Southeast Ethiopia, 2026.
Factors Associated with Abnormal Glomerular Filtration Rate
Different independent variables were selected, and binary logistic regression analysis was performed. However, those with a P-value < 0.25 in the binary logistic analysis were selected as candidates for multiple logistic regression analysis. Accordingly, factors associated with abnormal glomerular filtration rate among patients with tuberculosis before anti-tuberculosis therapy were nausea and cough (Table 3).
Table 3.
Factors Associated with Abnormal Glomerular Filtration Before Anti-Tuberculosis Therapy Among Tuberculosis Patients at Bale Zone Hospitals, Southeast Ethiopia, 2026 (N=288)
| Variables | Category | GFR | COR(95% CI) | AOR(95% CI) | P-value | |
|---|---|---|---|---|---|---|
| Abnormal | Normal | |||||
| Night sweating | Yes | 12 | 89 | 2.2(0.9–5.1) | 1.2(0.37–3.7) | 0.78 |
| No | 11 | 176 | 1 | 1 | ||
| Anorexia | Yes | 12 | 101 | 1.8(0.8–4.2) | 0.6(0.19–1.9) | 0.4 |
| No | 11 | 164 | 1 | 1 | ||
| Alcohol drinking | Yes | 7 | 44 | 2.2(0.9–5.7) | 2.5(0.9–6.9) | 0.07 |
| No | 16 | 221 | 1 | 1 | ||
| Cough | Yes | 17 | 113 | 3.8(1.5–9.9) | 3.3(1.2–9.2) | 0.019* |
| No | 6 | 152 | 1 | 1 | ||
| Smoking | Yes | 5 | 31 | 2.1(0.7–6.1) | 2.2(0.7–6.9) | 0.17 |
| No | 18 | 234 | 1 | |||
| Nausea | Yes | 16 | 103 | 3.6(1.4–9.0) | 3.4(1.01–11.1) | 0.047* |
| No | 7 | 162 | 1 | |||
Note: *Indicates P-value < 0.05.
Discussion
Early identification of glomerular filtration rate is paramount prior to tuberculosis treatment. Tuberculosis can affect kidney function, either directly or indirectly. Accordingly, this study aimed to identify the magnitude of the glomerular filtration rate and its associated factors prior to tuberculosis treatment. Hence, the magnitude of abnormal glomerular filtration was 7.99%, with a 95% CI: 5.13–11.74%. However, the magnitudes of abnormal glomerular filtration were 7.7% and 8.6% among pulmonary tuberculosis patients and extra pulmonary tuberculosis, respectively. In tuberculosis patients with anemia, the magnitude of abnormal glomerular filtration was 10.4% in this study. Compared to abnormal glomerular filtration among non-anemic tuberculosis patients, which was 6.6%, it was higher among tuberculosis patients with anemia. This difference could be due to the pathophysiological mechanism of glomerular filtration among tuberculosis patients with anemia. The glomerular filtration rate decreased among anemic patients due to vasoconstriction of the renal artery to shift blood flow to vital organs. Hence, the renal glomeruli become hypoxic, and the glomerular filtration rate is reduced. Similarly, a reduction in the glomerular filtration rate results in anemia due to the reduction in erythropoietin hormone production. Erythropoietin stimulates the production of bone marrow and red blood cells as a result of this hormone. Alteration of glomerular filtration is due to mycobacterial dissemination. Mycobacterium tuberculosis can disseminate to different organs via blood vessels. The veins in the lung with emboli-containing microorganisms fall into systemic circulation.31 Accordingly, M. tuberculosis migrates to the kidney, and the preferred place for colonization by M. tuberculosis is the medullary region.10 Granulomatous lesions occur with caseous necrosis, leading to tissue damage. At the cortex, renal lesions begin and heal when a person is resistant to the organism. Cortical granulomas form when bacilli migrate to the cortico-medullary junction.32 Granulomas formed at this site will remain stable for many years. However, after reactivation, these organisms invade the renal medulla and causes papillitis.33 Large areas of papillary necrosis can cause cavities and destroy renal parenchyma. Subsequently, they migrate to the collecting system.34 With disease progression, extensive areas of papillary necrosis can cause the formation of cavities that destroy the renal parenchyma and can migrate into the collecting system. In the renal papillae, papillary necrosis occurs due to infection that causes vascular insufficiency.35 Tuberculous pyelonephritis is caused by dissemination of infection to the renal pelvis. Granulomatous lesions associated with fibrosis result from the dissemination of the infection from the ureter to the bladder.36
The magnitude of abnormal glomerular filtration rate among tuberculosis in this study was in line with studies conducted in Korea (9%) and China (7.1%).26,37 However, the magnitude of abnormal glomerular filtration was lower compared to studies conducted in China (1.55%) and Taiwan (1.01%).27,38
In this study, factors associated with abnormal glomerular filtration were identified. Accordingly, nausea and cough were significantly associated with abnormal glomerular filtration rate among patients with tuberculosis. Tuberculosis patients who had nausea were about three times more likely to develop an abnormal glomerular filtration rate than their counterparts were (AOR=3.4). This could be due to tuberculosis patients with nausea not taking sufficient fluid. As a result, they can develop dehydration. Therefore, it results in a reduction in the glomerular filtration rate. Similarly, tuberculosis patients presented with cough were more likely to develop abnormal glomerular filtration rates compared to those presented without cough (AOR=3.3).
Conclusion
The magnitude of the abnormal estimated glomerular filtration rate was higher among tuberculosis patients with anemia. Nausea and cough were significantly associated with abnormal estimated glomerular filtration rate among patients with tuberculosis prior to anti-tuberculosis therapy. Development of abnormal glomerular filtration is higher among tuberculosis patients with cough and nausea.
Strength and Limitation
The strength of this study was that it was conducted prior to the initiation of anti-tuberculosis therapy. As a result, it identifies the risk factors early. The limitation of this study was the use of a single measurement of creatinine levels to estimate the glomerular filtration rate. Therefore, it cannot identify chronic kidney disease.
Acknowledgment
We thank study participants and data collectors.
Funding Statement
This study was supported by the Jimma University. The University supported as part of PhD research, but it has no role in the inception, study design, manuscript preparation, and publication decision.
Abbreviations
AOR, adjusted odds ratio; CI, confidence interval; EPTB, extra pulmonary Tuberculosis; GFR, glomerular filtration rate; TB, Tuberculosis; WHO, World Health Organization.
Data Sharing Statement
The datasets used and/or analyzed in the current study are available from the corresponding reasonable request.
Ethics Approval and Consent to Participate
This study was conducted with the ethical approval of the Jimma University Institutional Review Board. Since this is PhD research and the hospitals do not have their own research ethical committee, it was approved by Jimma University Institutional review board with a reference number of JUIH/IRB/0495/25. The study was conducted on their volunteer bases and they were informed about the benefits and risks. Written informed consent was obtained from each study participant before the commencement of the study. This study was conducted in accordance with the principles of the Declaration of Helsinki. All the information obtained from each study participant was coded to maintain confidentiality.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
There are no conflicts of interest in this work.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets used and/or analyzed in the current study are available from the corresponding reasonable request.