rifampin and Nephrotic-Syndrome

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

Inducing remission in nephrotic children on anti-tubercular therapy is difficult due to the increased metabolism of prednisolone induced by rifampicin. We report a child with nephrotic syndrome treated successfully with an increased dose of steroids without discontinuing anti-tubercular therapy.

Topics: Child; Dose-Response Relationship, Drug; Drug Interactions; Female; Glucocorticoids; Humans; Nephrotic Syndrome; Nucleic Acid Synthesis Inhibitors; Prednisolone; Rifampin

Cyclosporine (CsA) is widely used in the treatment of nephrotic syndrome (NS). A population pharmacokinetic (PopPK) model was developed using trough blood CsA concentration data from 106 patients with NS. The pharmacokinetic analysis was performed using NONMEM with 1-compartment linear model and first-order elimination. Proportional and additive error models were used to describe the interindividual and intraindividual variabilities, respectively. Body weight (WT), serum albumin level (ALB), and combination therapy with rifampicin were found to be the most significant covariates explaining the variability of the apparent clearance (CL/F) of CsA among patients. The final model was as follows: TVCL/F=34.1x(WT/67.6)(1.08)x(1+RFAx0.67)x(1-ALBx0.0088); TVV/F=3.5xWT; Ka=1.28 fixed; where RFA=1 with concurrent rifampicin use and 0 otherwise. The interindividual variabilities of CL/F and V/F were 18% and 27%, respectively. The residual error was 0.064 mg/L. The mean+/-SD of CL/F and V/F of the 106 patients were 23.5+/-7.2 L/h and 232.3+/-71.5 L, respectively. The reliability and stability of the PopPK model were confirmed by nonparametric bootstrap procedure.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Cohort Studies; Cyclosporine; Drug Interactions; Female; Humans; Immunosuppressive Agents; Linear Models; Male; Middle Aged; Nephrotic Syndrome; Rifampin

Topics: Adult; AIDS-Associated Nephropathy; Antibiotics, Antitubercular; Biopsy; Female; Humans; Kidney; Nephritis, Interstitial; Nephrotic Syndrome; Rifampin

Topics: Drug Antagonism; Drug Resistance; Drug Therapy, Combination; Humans; Infant; Male; Nephrotic Syndrome; Prednisolone; Rifampin

We have investigated changes in the pharmacokinetics of prednisolone caused by co-administration or discontinuation of rifampin. Serial IV pharmacokinetic studies of prednisolone (1 mg/kg) in groups of 3 patients over a 1 month period of rifampin co-treatment or after its withdrawal, revealed significant changes in the area under the curve, the total clearance, the non-renal clearance and the half-life. The changes in the pharmacokinetic parameters reached a 1.5 to 2-fold plateau after 2 weeks and the half maximal effect was attained within 5 days. Neither the volume of distribution nor the protein binding of prednisolone were significantly altered.

Topics: Adult; Drug Interactions; Female; Half-Life; Humans; Lupus Erythematosus, Systemic; Male; Metabolic Clearance Rate; Middle Aged; Nephrotic Syndrome; Prednisolone; Protein Binding; Rifampin; Time Factors

A patient with systemic brucellosis due to Brucella melitensis had severe renal involvement. Clinical features included hypertension, macroscopic haematuria, massive proteinuria of 10 g per 24 hours and azotaemia. Following treatment with antibiotics, the azotaemia resolved and proteinuria decreased to less than 0.5 g per 24 hours, but microscopic haematuria and hypertension persisted. Renal biopsy during recovery revealed IgA nephropathy with minimal mesangial changes, suggesting a causal relation between brucellosis and IgA nephropathy with a reversible nephrotic syndrome.

Topics: Adult; Brucellosis; Doxycycline; Female; Glomerulonephritis, IGA; Humans; Nephrotic Syndrome; Rifampin

Topics: Acute Kidney Injury; Adult; Humans; Male; Nephrotic Syndrome; Polymorphism, Genetic; Rifampin

Topics: Adrenal Cortex Hormones; Adult; Drug Therapy, Combination; Humans; Male; Nephrotic Syndrome; Rifampin

Two months after commencing continuous treatment with rifampicin, isoniazid, streptomycin and pyrazinamide for pulmonary tuberculosis a patient developed a nephrotic syndrome, acute nonoliguric renal failure and evidence of intravascular hemolysis. Renal biopsy revealed a severe crescentic nephritis with mild interstitial changes. The use of rifampicin has been associated with various renal abnormalities and this report documents the occurrence of a rapidly progressive crescentic glomerulonephritis presenting as nephrotic syndrome in a patient receiving continuous treatment with rifampicin.

Topics: Acute Disease; Acute Kidney Injury; Adult; Glomerulonephritis; Humans; Kidney Glomerulus; Male; Nephrotic Syndrome; Rifampin; Tuberculosis, Pulmonary

Topics: Child; Drug Interactions; Humans; Male; Nephrotic Syndrome; Prednisolone; Rifampin

Topics: Animals; Haplorhini; Macaca mulatta; Nephrotic Syndrome; Rifampin