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Rifampicin in Nontuberculous Mycobacterial Infections: Acute Kidney Injury with Hemoglobin Casts

Rishi Kora1, Sergey V Brodsky2, Tibor Nadasdy2

  • 1Mount Carmel West Hospital, Columbus, OH, USA.

Case Reports in Nephrology
|June 1, 2018
PubMed

Insights

Rifampicin can cause rare but serious kidney injury through intravascular hemolysis, particularly when treatment is intermittent or resumed after a break. Prompt recognition is crucial for patient outcomes.

Area of Science:

  • Nephrology
  • Pharmacology
  • Pathology

Background:

  • Rifampicin is essential for treating tuberculosis and rising nontuberculous mycobacterial (NTM) infections.
  • Hepatotoxicity is a known Rifampicin side effect, requiring liver function monitoring.
  • Acute kidney injury (AKI) from Rifampicin is rare, often linked to allergic interstitial nephritis.

Observation:

  • This case highlights an uncommon Rifampicin complication: intravascular hemolysis leading to hemoglobinuria and AKI.
  • This severe adverse event is particularly rare in Western countries.
  • Antibody-mediated hemolysis is implicated, often occurring with intermittent Rifampicin therapy or upon re-initiation.

Findings:

  • The patient presented with AKI, a serious complication of Rifampicin.
  • Biopsy revealed acute tubular necrosis (ATN) with intratubular hemoglobin casts.
  • This indicates Rifampicin-induced intravascular hemolysis as the cause of kidney injury.

Implications:

  • Increased awareness of Rifampicin-induced hemolysis and AKI is vital for emergency physicians, nephrologists, and pathologists.
  • Understanding the specific timing (intermittent or re-initiated therapy) is key for diagnosis.
  • Early recognition and intervention can prevent severe kidney damage.

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