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Acute tubulo-interstitial nephritis requiring dialysis associated with intermittent rifampicin use: case report
M Gallieni1, P Braidotti, M Cozzolino
1Second Department of Pathology, University of Milano, San Paolo Hospital, Italy. gallieni@iol.it
Abstract:
Rifampicin is one of the most effective antibiotics used for the treatment of tuberculosis and severe staphylococcal infections. Intermittent administration of high doses of rifampicin has been associated with frequent adverse reactions, including hepatotoxicity and nephrotoxicity, sometimes resulting in acute renal failure. We describe a case of rifampicin-associated acute renal failure, with biopsy findings of tubulointerstitial nephritis; inflammatory cells were characterized by immunohistochemistry, which showed immunoreactivity for CD3 and CD5 (T lymphocytes) and for CD68 (macrophages). The patient presented with a very rapid systemic reaction to the offending drug and rapid deterioration of renal function, which required dialysis treatment. The response to rifampicin discontinuation was excellent: no further therapy was required, as renal function began to improve within several days and returned to normal values (serum creatinine 1.17 mg/dl) seven months after the onset of symptoms. When prescribing rifampicin the physician should investigate previous use of the drug, because re-exposure is a critical factor in predicting the possibility of drug-induced acute renal failure.
Insights
High-dose rifampicin can cause acute kidney injury, specifically tubulointerstitial nephritis. Physicians should inquire about prior rifampicin use to prevent severe adverse reactions and acute renal failure.
Area of Science:
- Nephrology
- Pharmacology
- Pathology
Background:
- Rifampicin is a crucial antibiotic for tuberculosis and staphylococcal infections.
- High-dose intermittent rifampicin use is linked to adverse effects like hepatotoxicity and nephrotoxicity.
- Acute renal failure is a potential severe complication of rifampicin therapy.
Observation:
- A case study details a patient experiencing acute renal failure following rifampicin administration.
- Renal biopsy revealed tubulointerstitial nephritis with T lymphocyte and macrophage infiltration.
- The patient showed a rapid systemic reaction and rapid decline in renal function, necessitating dialysis.
Findings:
- Discontinuation of rifampicin led to excellent recovery of renal function.
- Renal function normalized within seven months without further specific treatment.
- Immunohistochemistry confirmed T lymphocytes (CD3, CD5) and macrophages (CD68) in the affected renal tissue.
Implications:
- Physicians must ascertain previous rifampicin exposure due to heightened risk upon re-exposure.
- Awareness of potential acute renal failure is critical for safe rifampicin prescription.
- This case highlights the importance of vigilant monitoring for drug-induced nephrotoxicity.