Nephrol Dial Transplant (2001) 16: 190-191
© 2001 European Renal Association-European Dialysis and Transplant Association
Letters
Continuous rifampicin administration inducing acute renal failure
Nephrology Department, Pitié-Salpétrière Hospital, Paris, France
Sir,
Rifampicin is one of the major antituberculous drugs used for a disease increasing world-wide. This antibiotic is also a common treatment for severe staphylococcal infections [1]. Numerous side-effects have been reported in rifampicin-treated patients. Acute renal failure (ARF) is a less-known toxicity that usually occurs in patients receiving intermittent or interrupted therapy [1,2]. Only few cases of ARF following a first daily continuous course have been reported and most of them were secondary to acute tubular necrosis [1,3]. We present a case of acute interstitial nephritis due to a continuous rifampicin treatment.
Case.
A 61-year-old alcoholic male weighing 40 kg was treated for the first time for pulmonary tuberculosis by rifampicin 300 mg, isoniazid 150 mg, pyrazinamide 1000 mg, and ethambutol 600 mg daily. After 2 months pyrazinamide and ethambutol therapy were stopped. Ten weeks after starting the antituberculous therapy and while the patient was still receiving daily rifampicin and isoniazid, a non-oliguric rapidly progressive renal failure occurred. The laboratory data were haemoglobin 10 g/dl, leukocyte count 6700/mm3, platelet count 160 000/mm3, Na 138 mmol/l, K 3.9 mmol/l, Ca 2.54 mmol/l, glucose 5.2 mmol/l, blood urea nitrogen 20 mmol/l, and serum creatinine 472 µmol/l. Liver function tests were normal. Urine analysis showed proteinuria 1.5 g/24 h, absence of white blood cells, red blood cells, and light chains. Clinically there was no rash, arthropathy, lumbar pain, diarrhoea, or vomiting. Light microscopy of the renal biopsy showed features of an acute interstitial nephritis. There was no immunoglobulin deposits in the immunofluorescence fragment. Rifampicin-dependent antibodies were negative. Rifampicin was stopped and replaced by sparfloxacin. Renal function returned to normal level within 3 weeks after withdrawal of the rifampicin. The patient did not require dialysis and was discharged from the hospital 3 weeks later.
Comments.
Rifampicin treatment regimens are of three types: ‘continuous’, with a daily dose; ‘intermittent’, with ingestion of a dose one, two, three, or five times weekly; and ‘interrupted’, when therapy is resumed after a course of daily or intermittent treatment and a subsequent drug-free interval [1]. ARF due to acute tubular necrosis usually occurs in patients who receive intermittent or interrupted regimens [1,2]. These subjects may also present with intravascular haemolysis or thrombocytopenia with a fulminant systemic reaction [4]. Rifampicin-dependent antibodies are usually detected and even a single dose after a medication-free period may cause a severe reaction and may induce sensitization [4,5].
Fourteen cases (including our patient) of rifampicin-induced ARF have been reported after a daily continuous treatment [1,3]. Kidney biopsy revealed a rifampicin-induced interstitial nephritis in six of these 14 cases (43%). Four of these six patients (66%) required haemodialysis treatment. The recovery was complete in all six patients [1]. None of these patients received corticosteroids. Tests for rifampicin dependent antibodies were uniformly negative [4,5].
We suggest that continuous, non-interrupted mode of administration of rifampicin can be responsible for ARF due to an acute interstitial nephritis.
References
- De Vriese An S, Robbrecht DL, Vanholder RC, Vogelaers DP, Lameire NH. Rifampicin-associated acute renal failure: pathophysiology, immunologic and clinical features. Am J Kidney Dis1998; 31: 108–115[Web of Science][Medline]
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Covic A, Goldsmith DA, Segall L et al. Rifampicin-induced acute renal failure: a series of 60 patients. Nephrol Dial Transplant1998; 13: 924–929
[Abstract/Free Full Text] - Power DA, Russell G, Smith W et al. Acute renal failure due to continuous rifampicin. Clin Nephrol1983; 20: 155–159[Medline]
- Diamond JR, Tahan SR. Ig G-mediated intravascular hemolysis and nonoliguric acute renal failure complicating discontinuous rifampicin administration. Nephron1984; 38: 62–64[Medline]
- Mauri JM, Fort J, Bartolome J et al. Antirifampicin antibodies in acute rifampicin-associated renal failure. Nephron1982; 31: 177–179.[Medline]
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