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Rifampicin-Associated Secondary Minimal Change Disease Presenting with Nephrotic Syndrome in a Pulmonary Tuberculosis

Satyanand Sathi1, Anil Kumar Garg1, Manoj Kumar Singh1

  • 1Department of Medicine, S.M.M.H. Government Medical College, Saharanpur, Uttar Pradesh, India.

Case Reports in Nephrology
|May 3, 2021
PubMed

Insights

Rifampicin, an antibiotic for tuberculosis, can rarely cause secondary minimal change disease (MCD) leading to nephrotic syndrome. Discontinuation of the drug resulted in complete remission, highlighting its potential nephrotoxicity.

Area of Science:

  • Nephrology
  • Pharmacology
  • Pathology

Background:

  • Drug-induced secondary minimal change disease (MCD) is often linked to hypersensitivity or direct toxicity.
  • Rifampicin is known for various nephrotoxic effects, but MCD induction is exceptionally rare.

Observation:

  • A young adult male developed nephrotic proteinuria after one month of rifampicin treatment for tuberculosis.
  • The patient had no prior proteinuria, and urine sediment was unremarkable.

Findings:

  • Renal biopsy revealed nonproliferative glomerulopathy with effaced foot processes on electron microscopy.
  • Immunofluorescence and electron microscopy excluded immune deposits and basement membrane thickening, confirming minimal change nephrotic syndrome.

Implications:

  • This case underscores the rare but significant nephrotoxicity of rifampicin, specifically its potential to induce minimal change disease.
  • Prompt recognition and drug withdrawal are crucial for managing rifampicin-induced nephrotic syndrome and achieving remission.

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