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Acute tubulointerstitial nephritis caused by rifampicin: An increasing and often overlooked side effect in elderly

Manabu Nagata, Goh Ohji, Kentaro Iwata

    International Journal of Clinical Pharmacology and Therapeutics
    |February 11, 2019
    PubMed
    Abstract

    Insights

    Acute renal failure from antituberculous drugs, particularly rifampicin, is a rare but serious side effect. Physicians must be aware of this risk, especially in elderly patients, as standard tests may not identify the cause.

    Area of Science:

    • Nephrology
    • Infectious Diseases
    • Pharmacology

    Background:

    • Antituberculous drugs can cause various side effects, with renal failure being uncommon but potentially underrecognized.
    • This case highlights a patient experiencing acute renal failure during treatment for tuberculous pleuritis.

    Observation:

    • A 64-year-old male developed worsening renal function six weeks after initiating isoniazid, rifampicin, and ethambutol.
    • Renal biopsy confirmed acute interstitial nephritis, and while prednisolone improved function, the causative agent was unclear.
    • A drug-induced lymphocyte stimulation test (DLST) did not identify the specific antituberculous drug responsible.

    Findings:

    • Rifampicin is suspected as the most likely cause of acute interstitial nephritis despite negative DLST results.
    • Renal failure is increasingly recognized as a complication of antituberculous therapy in the elderly.

    Implications:

    • Physicians administering antituberculous therapy need heightened awareness of potential renal side effects, especially in older individuals.
    • Current diagnostic tests like DLST may be insufficient for identifying drug-induced renal injury; alternative methods like the leukocyte migration test warrant further investigation.

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