Rifampicin-induced acute renal failure: a series of 60 patients
Nephrology, Dialysis and Transplantation
complications which are associated with a more severe renal injury. Background. Since 1971, 55 case-reports of rifampicininduced ARF have been published, but systematic data on this condition are not available, in view of the Key words: acute renal failure (ARF ); rifampicin; disparate nature of the observations. haemolytic anaemia; thrombocytopenia; hepatic injury Methods. We retrospectively assessed prevalence, clinical and biochemical features, and prognostic factors of 60 consecutive cases
... consecutive cases (41 males/19 females, age 22-68 years), who were admitted to the Iasi Dialysis Centre Introduction from 1987 to 1995 for acute renal failure (ARF ) following re-treatment with rifampicin. Rifampicin is one of the major antituberculosis drugs Results. The clinical appearance consisted mainly of and a second choice antistaphylococcal agent. The gastrointestinal and 'flu-like' symptoms and clinical prevalence of tuberculosis is increasing world-wide, signs of intravascular haemolysis (the latter in 17% of particularly in Romania. The antituberculous regimen cases). Frequent laboratory findings were anaemia recommended in our country until 1995 specifically (96% of cases), leukocytosis (63%), and thrombocytoincluded a twice weekly dose of rifampicin. penia (50%). Severe anaemia was associated with Renal toxicity of rifampicin has been reported spormarked haemolysis (25% cases), thrombocytopenia, adically. Since the first description by Poole et al. in longer anuria, and slower rate of renal function recov-1971 , 54 case-reports of rifampicin-induced ARF ery. Signs of hepatic injury were found in 25% of have been published . The deterioration in renal patients, but it did not seem to affect the outcome of function typically appears acutely, after reintroduction renal function. of rifampicin 15,     28,       , deter-Prognostic factors in post-rifampicin ARF proved mined by an acute tubulointerstitial nephritis and/or to be the following: the duration of the anuric phase acute tubular necrosis [6,. However, some (correlated with the number of dialysis sessions and authors have reported cases occurring during continuwith the rate of decrease of azotaemia) and the severity ous rifampicin therapy 21, 22, 27, 36, 43]. of the immunological abnormalities and inflammatory In addition to the expected interstitial lesions secondary syndrome (haemolysis, leukocytosis, hypergammato the immunoallergic mechanism, isolated or superglobulinaemia). imposed glomerular injury  have been described, Post-rifampicin ARF accounted for 16.6% of all presenting either with a rapidly progressive picture ARF cases hospitalized in our Centre during the [20,21], or as a frank nephrotic syndrome [16, 22, 23] . studied period. Its clinical course was favourable; the Apparently, post-rifampicin ARF is characterismortality rate was only 1.6% (1 case), compared to a tically associated with autoimmune haemolysis 20% general mortality rate among all ARF patients. 8,15,18,21,     48, 52], which is sometimes Full recovery of renal function was achieved in 40% severe [6,8,27,28], thrombocytopenia [15,27,28,30], and 96% of patients, 30 and 90 days respectively disseminated intravascular coagulation [27, 28] , hepatic from onset. injury     , or tubular defects 19], thus Conclusions. ARF after treatment with rifampicin is creating a very polymorphic appearance [6, 23] . not an uncommon condition, especially when tubercu-Although, evidence is now accumulating in favour of losis prevalence is high, but renal prognosis is usually a clear, distinct entity, a definite clinical, biological favourable. Thrombocytopenia, immune haemolytic picture of post-rifampicin ARF, has not been estabanaemia, and intravascular haemolysis are frequent lished, because of disparate observations. Also, important data concerning prevalence and prognosis are Correspondence and offprint requests to: Dr Adrian Covic, Clinica a generally missing.