rifampin and Proteinuria

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

A 31-year-old man who presented with smear- and culture-negative pulmonary tuberculosis had associated macroscopic hematuria, elevation of serum creatinine and immunoglobulin A (IgA) levels, overt proteinuria, and peripheral edema. Renal biopsy revealed focal mesangial proliferation with IgA deposits, and a diagnosis of IgA nephropathy was made. The patient received treatment with isoniazide and rifampin. After 4 months, pulmonary lesions were almost completely healed, and a significant improvement of creatinine clearance with normalization of serum creatinine and IgA levels and disappearance of proteinuria were observed. Treatment with isoniazide and rifampin was discontinued after 6 months, without reappearance of either pulmonary or renal symptoms. Two years after the diagnosis of IgA nephropathy, the patient is in good general condition. Serum creatinine and IgA levels are normal, proteinuria is absent, and there is neither macrohematuria nor microhematuria. These findings suggest that IgA nephropathy may be a consequence of tuberculosis, possibly due to an abnormal IgA-mediated immune response against Mycobacterium tuberculosis with formation of nephrotoxic immune complexes.

Topics: Adult; Anti-Bacterial Agents; Antibiotics, Antitubercular; Creatinine; Drug Therapy, Combination; Fluorescent Antibody Technique, Direct; Glomerulonephritis, IGA; Hematuria; Humans; Immunoglobulin A; Isoniazid; Male; Proteinuria; Rifampin; Tomography, X-Ray Computed; Treatment Outcome; Tuberculosis, Pulmonary

Topics: Acute Kidney Injury; Dehydration; Humans; Immunoglobulin Light Chains; Male; Middle Aged; Proteinuria; Rifampin

A patient who was receiving rifampin treatment for tuberculosis developed heterogenous light-chain proteinuria and insidious renal failure after a period of fluid restriction. The renal damage was characterized pathologically by an interstitial nephritis with invasive tubular casts and an associated renal vein thrombosis. The possible role of the light-chain proteinuria in the pathogenesis of the renal failure is discussed.

Topics: Acute Kidney Injury; Dehydration; Humans; Immunoglobulin Light Chains; Male; Middle Aged; Nephritis, Interstitial; Proteinuria; Rifampin

Topics: Acute Kidney Injury; Aged; Ethambutol; Female; Humans; Immunoglobulin Light Chains; Isoniazid; Male; Middle Aged; Proteinuria; Rifampin; Tuberculosis, Lymph Node; Tuberculosis, Renal

Light chain proteinuria was found in 9 of 17 tuberculosis patients treated with rifampin. Concomitant assay of cellular mediated immunity in these patients using skin test antigen and a lymphokine in vitro test provided results that were different. Response to Varidase skin test antigen was negative for all eight tuberculosis patients tested, but there occurred a hyper-responsiveness of the lymphocytes of these eight patients to phytomitogen (PHA-P). as well as of those of seven other tuberculous patients. This last finding may be related to time of testing and/or endogenous serum binding of rifampin which could have inhibited mitogen activity for the lymphocyte.

Topics: Adult; Aged; Humans; Immunity, Cellular; Immunoglobulin Fragments; Immunoglobulin kappa-Chains; Immunoglobulin lambda-Chains; In Vitro Techniques; Lymphocyte Activation; Middle Aged; Proteinuria; Rifampin; Skin Tests; Tuberculosis

Topics: Acute Kidney Injury; Antibody Formation; Drug Hypersensitivity; Humans; Male; Middle Aged; Proteinuria; Rifampin; Specific Gravity; Tuberculosis, Pulmonary

Topics: Antibody Formation; Antigen-Antibody Reactions; Hemocyanins; Humans; Proteinuria; Rifampin; Salmonella; Tuberculosis; Tuberculosis, Pulmonary; Vaccines