Rifampicin-induced acute renal failure: a series of 60 patients

A. Covic, D. Goldsmith, L. Segall, C. Stoicescu, S. Lungu, C. Volovat, M. Covic
1998 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
more » ... 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 [1], 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 [1][2][3][4][5][6][7][8]15, [23] [24] [25] [26] 28, [30] [31] [32] [37] [38] [39] [40][41], 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,[9][10][11][12][13][14][15][16]. 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 [13][14][16][17][18][19]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 [12] 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. [4][5][6]8,15,18,21, [25] [26] [27] [28] 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 [31] [32] [33] [34] , or tubular defects [13][14][15]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.
doi:10.1093/ndt/13.4.924 pmid:9568851 fatcat:gzagnno7zvg3dfdp66idnfp6fu