rifampin and Nephrosis--Lipoid

The standard drugs used to treat tuberculosis are rifampicin and isoniazid. These agents are usually safe and inexpensive for short-term use in treatment of latent tuberculosis infection, but sometimes cause adverse renal effects, including minimal change disease (MCD).. Here, we report a 51-year-old woman with latent tuberculosis infection who developed nephrotic syndrome during treatment with rifampicin and isoniazid for 25 days.. Renal biopsy findings were compatible with MCD, and she had no relevant medical history and was not taking other medications. A diagnosis of anti-tuberculosis drug- induced MCD was made. This is the first report of acute renal failure due to rifampicin and/or isoniazid-induced MCD.. After cessation of rifampicin and isoniazid, however, acute renal failure progressed and she was treated with temporary dialysis and oral prednisolone.. The patient achieved complete remission after cessation of rifampicin and isoniazid with steroid therapy.. This case demonstrates that rifampicin and/or isoniazid can cause nephrotic syndrome with acute renal failure during the first months of continuous latent tuberculosis therapy. Therefore, renal function and proteinuria should be monitored carefully in all patients taking rifampicin and isoniazid, especially during the first few months of therapy.

Topics: Acute Kidney Injury; Antitubercular Agents; Female; Glucocorticoids; Humans; Isoniazid; Latent Tuberculosis; Middle Aged; Nephrosis, Lipoid; Nephrotic Syndrome; Prednisolone; Proteinuria; Remission Induction; Renal Dialysis; Rifampin; Treatment Outcome

There are several reports to demonstrate that rifampicin, a major anti-tuberculosis agent, is associated with some adverse renal effects, with a few cases of rifampicin-induced minimal change disease (MCD). In the present case, a 68-year-old female presented with nausea, vomiting, foamy urine, general weakness and edema. She had been taking rifampicin for 4 weeks due to pleural tuberculosis. The patient had no proteinuria before the anti-tuberculosis agents were started, but urine tests upon admission showed heavy proteinuria with a 24-h urinary protein of 9.2 g/day, and serum creatinine, albumin, and total cholesterol levels were 1.36 mg/dL, 2.40 g/dL, and 283 mg/dL, respectively. MCD was diagnosed, and the patient achieved complete remission after cessation of rifampicin without undergoing steroid therapy.

Topics: Aged; Antibiotics, Antitubercular; Edema; Female; Humans; Kidney Function Tests; Kidney Glomerulus; Nausea; Nephrosis, Lipoid; Proteinuria; Remission Induction; Rifampin; Treatment Outcome; Tuberculosis, Pleural

Topics: Adult; Antibiotics, Antitubercular; Female; Humans; Kidney Glomerulus; Microscopy, Electron; Nephrosis, Lipoid; Rifampin

We describe nephrotic syndrome occurring in a 53-year-old male patient on continuous rifampicin (RFP) therapy for pulmonary tuberculosis. After the pulmonary tuberculosis was improved by chemotherapy that included RFP, administration of Isoniazid and RFP was continued. After 16 weeks, he suddenly developed nephrotic syndrome, but never developed acute renal failure. He was admitted to hospital and renal biopsy was performed revealing minor glomerular abnormalities and few interstitial changes in light microscopy. No positive immunofluorescent microscopic findings were obtained without fibrinogen. Thus, minimal change nephrotic syndrome (MCNS) was diagnosed. In contrast, electron microscopy showed several injurious glomerular changes, such as the elevation of the endothelial layer, local widening of the subendothelial space which was filled with fine granular or fibrillar materials, irregularity of the endothelial investment, swelling or shrinkage of the endothelial cells, compatible with those seen in many diseased conditions supposedly caused by clinical or subclinical localized intravascular coagulation. Discontinuation of RFP administration completely relieved the patient of MCNS with the aid of predonisolone therapy. Thus, this patient might not have been a case of incidental, but rather drug (RFP)-induced MCNS.

Topics: Humans; Kidney Glomerulus; Male; Microscopy, Electron; Middle Aged; Nephrosis, Lipoid; Rifampin; Tuberculosis, Pulmonary