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Nephrology Dialysis Transplantation, Vol 13, Issue 4 924-929, Copyright © 1998 by Oxford University Press
A Covic, D Goldsmith, L Segall, C Stoicescu, S Lungu, C Volovat and M Covic
Background: Since 1971, 55 case-reports of
rifampicin-induced ARF have been published, but systematic data on this
condition are not available, in view of the disparate nature of the
observation. Methods: We retrospectively assessed
prevalence, clinical and biochemical features, and prognostic factors of 60
consecutive cases (41 males/19 females, age 22-68 years), who were admitted
to the Iasi Dialysis Center from 1987 to 1995 for acute renal failure (ARF)
following re-treatment with rifampicin. Results: The
clinical appearance consisted mainly of gastrointestinal and 'flu-like-'
symptoms and clinical signs of intravascular haemolysis (the latter in 17%
of cases). Frequent laboratory findings were anaemia (96% of cases),
leukocytosis (63%), and thrombocytopenia (50%). Severe anaemia was
associated with marked haemolysis (25% cases), thrombocytopenia longer
anuria, and slower rate of renal function recovery. Signs of hepatic injury
were found in 25% of patients, but it did not seem to affect the outcome of
renal function. Prognostic factors in post-rifampicin ARF proved to be the
following: the duration of the anuric phase (corelated with the number of
dialysis sessions and with the rate of decrease of azotaemia) and the
severity of the immunological abnormalities and inflammatory syndrome
(haemolysis, leukocytosis, hypergammaglobulinaemia). Post-rifampicin ARF
accounted for 16.6% of all ARF cases hospitalized in our Centre during the
studied period. Its clinical course was favourable; the mortality rate was
only 1.6% (1 case), compared to a 20% general mortality rate among all ARF
patients. Full recovery of renal function was achieved in 40% and 96% of
patients, 30 and 90 days respectively from onset.
Conclusions: ARF after treatment with rifampicin is
not an uncommon condition, especially when tuberculosis prevalence is high,
but renal prognosis is usually favourable. Thrombocytopenia, immune
haemolytic anaemia, and intravascular haemolysis are frequent complications
which are associated with a more severe renal injury. Key
words: acute renal failure (ARF); rifampicin; haemolytic
anaemia; thrombocytopenia; hepatic injury
ORIGINAL ARTICLES
Rifampicin-induced acute renal failure: a series of 60 patients
Clinica a IV-a Medicala-Nefrologie, Spitalul 'C. I. Parhon', Bld. Copou Nr 50, Iasi, 6600, Romania; Corresponding author
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