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Prolonged renal failure after rifampin

V K Bansal, D Bennett, Z Molnar

    The American Review of Respiratory Disease
    |July 1, 1977
    PubMed
    Summary
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    Rifampin, a tuberculosis drug, can cause acute kidney injury (AKI) with symptoms like rash and elevated creatinine. This case highlights a potential new risk associated with rifampin treatment, especially with liver issues.

    Area of Science:

    • Nephrology
    • Pharmacology
    • Infectious Diseases

    Background:

    • Pulmonary tuberculosis requires multi-drug therapy, often including rifampin.
    • Rifampin is a crucial antibiotic for tuberculosis treatment.
    • Drug-induced kidney injury is a significant clinical concern.

    Observation:

    • A 45-year-old male patient on daily rifampin for tuberculosis developed acute renal failure.
    • Clinical manifestations included rash, eosinophilia, and elevated kidney function markers (blood urea nitrogen and creatinine).
    • The patient experienced a prolonged recovery course with incomplete renal function restoration.

    Findings:

    • Renal biopsy revealed tubulointerstitial nephritis with non-specific glomerular changes.
    • Immunofluorescence demonstrated immune deposits (IgG, IgA, IgM, C3) in glomeruli and IgE along tubules.

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  • These findings suggest an immune-mediated mechanism for the observed kidney injury.

    • Implications:

    • This case report identifies a potential new adverse effect of rifampin therapy.
    • Coexisting hepatic dysfunction may exacerbate or contribute to rifampin-induced nephrotoxicity.
    • Awareness of this potential complication is crucial for clinicians managing tuberculosis patients.