Rifampin-associated tubulointersititial nephritis and Fanconi syndrome presenting as hypokalemic paralysis

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Hong Ki Min1, Eun Oh Kim, Sang Ju Lee

  • 1Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea.

BMC Nephrology
|January 17, 2013
PubMed
Abstract

Insights

Rifampin, a tuberculosis drug, can cause Fanconi syndrome and hypokalemic paralysis due to acute tubulointerstitial nephritis (ATIN). Monitoring kidney function is crucial for patients on rifampin.

Area of Science:

  • Nephrology
  • Pharmacology
  • Internal Medicine

Background:

  • Rifampin is a key first-line tuberculosis treatment.
  • Renal toxicity, including acute tubulointerstitial nephritis (ATIN), is a known but infrequent adverse effect of rifampin.
  • This report details a novel case of ATIN co-occurring with Fanconi syndrome.

Observation:

  • A 42-year-old male presented with paralysis and renal insufficiency after two months of tuberculosis treatment (isoniazid, rifampin, ethambutol).
  • Diagnostic workup revealed profound hypokalemia, metabolic acidosis, and evidence of generalized proximal tubular dysfunction (Fanconi syndrome), including aminoaciduria, glycosuria, and phosphaturia.
  • Kidney biopsy confirmed ATIN with immunoglobulin A and complement 3 deposits.

Findings:

  • The patient's Fanconi syndrome, hypokalemic paralysis, and renal insufficiency resolved upon discontinuation of rifampin.
  • Histopathology indicated acute tubulointerstitial nephritis (ATIN) with specific glomerular and tubular deposits.
  • Electron microscopy revealed podocyte foot process effacement and subendothelial deposits.

Implications:

  • Rifampin therapy can precipitate Fanconi syndrome presenting as hypokalemic paralysis, a manifestation of ATIN.
  • Clinicians should monitor renal function and proximal tubular injury markers in patients treated with rifampin.
  • This case highlights the importance of considering drug-induced nephrotoxicity in patients with unexplained electrolyte disturbances and renal dysfunction.

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