Chevalier JP, Plantier J. Complication with rifampicin therapy: one case with anuria. Poumon Coeur 1980;36(4):287-91. 10. Mauri M, Fort J. Antirifampicin ...
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ACUTE RENAL FAILURE REQUIRING DIALYSIS ASSOCIATED WITH RIFAMPICIN USE
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2. Chon JR, Fye DL. Rifampin induced renal failure. Tubercle 1985;66(4):289-93
3. Prakash J, Kumar NS. Acute renal failure complicating rifampin therapy. J Assoc Physicians India
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4. Calfee DP. Rifamycins. In: Principles and practice of infectious diseases. 6 th ed. Elsevier; 2005. P. 374-83.
6. Power DA, Russel G. Acute renal failure due to continuous rifampicin. Clin Nephrol 1983;20(3): 155-9. Diamond JR, Tahan SR. IgG-mediated intravascular hemolysis and nonoliguric acute renal failure complicating discontinuos rifampin admi- nistration. Nephron 1984;38(1):62-4.
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Tsai TL, Lee CH. Acute renal failure caused by rifampicin reexposure with 10 year interval. Chang Gung Med J 2001;24(11):729-33.
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Chevalier JP, Plantier J. Complication with rifampicin therapy: one case with anuria. Poumon Coeur 1980;36(4):287-91.
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10. Mauri M, Fort J. Antirifampicin anibodies in acute rifampicin associated renal failure. Nephron 192; 31(2):177-9. 1074 Letter to the Editor
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11. Prakash J, Kumar NS, Saxena RK, Verma U. Acute renal failure complicating rifampicin therapy. J Assoc Physicians India. 2001 Sep;49:877-80.
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5. Qunibi WY, Godwin J. Toxic nephropathy during continuous rifampin therapy. South Med J 1980;73(6):791-2.
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References
1. Gupta A, Sakhuja V. Intravascular hemolysis and acute renal failure following intermittent rifampin therapy. Int J Leper Other Mycobact Dis 1992;60 (2):185-8.
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Conclusion
When a patient on ATT presents with deterioration of renal function, Rifampicin should be suspected as the cause after other causes of renal failure have been excluded.
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Rifampicin induced Acute renal failure has been attributed either to acute tubular necrosis4 or interstitial nephritis4-6. Acute renal failure can be nonoliguric7, oliguric8 or anuric9. Our patient had anuric ARF. Rifampicin dependent antibodies have been detected in the serum of most patients4, 10. Most anti-rifampicin antibodies are of the IgM class8. Kidney injury is usually the result of a complement mediated reaction between the rifampicin antibodies and antigens expressed on the renal tubular epithelium4. The prognosis of rifampicin associated renal failure is excellent and nearly all the reported patients fully recover their renal function within several weeks4. Intermittent or interrupted therapy appears to be a significant risk factor for the development of acute renal failure11.
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Cervical lymphadenopathy, minimal guarding and tenderness in the right hypochondrium, hepatomegaly of 2cms below the right costal margin, liver span of 15cms. Neutrophilic leucocytosis (25,400 WBCs/mm3 with 95% neutrophils), thrombocytopenia (platelet count1,01,000/mm3), renal failure (creatinine-4.1, urea-97) and indirect hyperbilirubinemia (total bilirubin-5.4, direct bilirubin-0.2, AST-62, ALT-18, ALP-100). Workup done for renal failure i.e. ANA, cANCA, pANCA, C3, and C4 were normal. USG abdomen showed grade 1 renal parenchymal changes. The ATT was discontinued. Her fever and abdominal pain settled but she was anuric and went into recurrent attacks of pulmonary oedema. A nephrologists' opinion was sought and she was hemodialysed. She required a total of 8 hemodialyses after which her urine output improved and her creatinine came to normal- 1.0mg/dl. Her other labs i.e. TC, platelets and LFT also normalized. In view of her TB lymphadenitis, ATT with HRZE was restarted. She again had fever with chills and rigors and oliguria after reintroduction of Rifampicin. So, rifampicin was excluded from the ATT regimen and the other drugs were continued with the addition of a quinolone. She was discharged from the hospital and has come for monthly follow up. On follow up, she reported decrease in the neck swelling, improved appetite and weight and no fever. Her RFT were normal. She has successfully completed ATT and is doing well.
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Management and course in the hospital
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PR- 110/min, BP- 98/60 mm Hg, RR- 26/min, Temp-100.4oF
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Fever, abdominal pain and vomiting since 10 days.
Lab data
Drug-induced acute interstitial nephritis with prominent interstitial inflammation characterized by lymphocytes, eosinophils, and focal plasma cells. Renal biopsy sample stained with hematoxylin and eosin; magnification 600.
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15 days later, she presented with…
Physical examination
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A 42 years old female presented to us with the history of a swelling in the neck since 6 months. She also reported occasional evening rise of temperature and loss of appetite. Her physical examination showed matted cervical lymphadenopathy. Her lab data especially RFT (creatinine 0.9) were normal. Her chest Xray was normal. A cervical lymph node biopsy was done and it was reported as Tubercular lymphadenitis with periadenitis. So, she was initiated on 4 drugs ATT (Anti-tubercular therapy) with HRZE (Isoniazid, Rifampicin, Pyrazinamide and Ethambutol) as per DOTS.
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Since 1971, 55 case-reports of rifampicin-induced acute renal failure (ARF) have been published. Covic et al described 60 consecutive cases of rifampicininduced ARF during a period of eight years (1987-1995) from Iasi Dialysis Centre, Romania.
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Introduction
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Rifampicin is one of the most effective antibiotics used for the treatment of tuberculosis. Rifampicin use has been associated with many adverse reactions, including hepatotoxicity and nephrotoxicity, sometimes resulting in acute renal failure 1, 2.
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Srikanth Prasad, Manjunatha Hande, Vasudeva Acharya, Nidhi Takkar, Veena S
