rifampin and Uremia

Itch is a global clinical problem and finding effective treatment remains a therapeutic challenge because of the complex pathophysiology of itch. The key component of treating itch should be directed at the underlying etiologies when possible. However, without eradication of the underlying diseases, treatment is often palliative at best. Treatment with systemic therapies can vary according to the etiology of the chronic itch. The aim of this article is to review the major systemic anti-itch agents and give a summary on the possible systemic treatments for different types of itch.

Topics: Amines; Analgesics; Analgesics, Opioid; Anion Exchange Resins; Antidepressive Agents; Aprepitant; Cholagogues and Choleretics; Cholestasis; Cholestyramine Resin; Cyclohexanecarboxylic Acids; Gabapentin; gamma-Aminobutyric Acid; Histamine Antagonists; Humans; Morpholines; Narcotic Antagonists; Neurokinin-1 Receptor Antagonists; Paraneoplastic Syndromes; Peripheral Nervous System Diseases; Pregabalin; Pruritus; Receptors, Opioid, kappa; Receptors, Opioid, mu; Rifampin; Thalidomide; Uremia; Ursodeoxycholic Acid

We report a patient who developed progressive renal failure following 13 months of rifampicin therapy for renal tuberculosis. The renal function continued to deteriorate despite the discontinuation of rifampicin. Renal pathology did not demonstrate any evidence of tuberculosis of the kidney but revealed the unique pathological finding of glomerulosclerosis, granulomatous interstitial nephritis, and extensive papillary necrosis.

Topics: Adult; Female; Glomerulosclerosis, Focal Segmental; Humans; Kidney Papillary Necrosis; Nephritis, Interstitial; Rifampin; Tuberculosis, Renal; Uremia

The aim of the present investigation is to study digitoxin and digoxin protein binding in patients with normal renal and hepatic function, in patients with uremia, and in patients under treatment with hemodialysis for renal failure. The binding of digitoxin and cardioactive metabolites to serum proteins was studied using equilibrium dialysis (an in vitro chemical assay) alone and in combination with a modified 86Rb method. The following values for protein binding were found: DT-3 (digitoxin), 95.7%; DT-2 (digitoxigenin-bis-digitoxoside), 96.5%; DT-1 (digitoxigenin-mono-digitoxoside), 98.7%; DT-0 (digitoxigenin), 92.7%; DG-3 (digoxin), 21.2%; DG-2 (digoxigenin-bis-digitoxoside), 16.3%; DG-1 (digoxigenin-mono-digitoxoside), 18.5%; and DG-0 (digoxigenin), 13.3%. In vitro addition of procainamide, phenytoin, heparin, and rifampicillin did not influence the in vitro binding of digitoxin. Protein binding of digitoxin showed small individual variations in patients with normal renal and hepatic function. Uremia per se did not influence the in vitro binding of digitoxin. There were marked changes in digitoxin and digoxin protein binding during an 8-hr hemodialysis, digitoxin binding decreasing from 97.1% to 93.7% (p less than 0.0025) and digoxin binding from 23.5% to 15.4% (p less than 0.05). In the uremic patient the metabolic pattern of digitoxin tended toward a decrease in protein-bound metabolites.

Topics: Blood Proteins; Digitoxin; Digoxin; Drug Interactions; Heparin; Humans; Kidney; Kidney Transplantation; Liver; Phenytoin; Procainamide; Protein Binding; Renal Dialysis; Rifampin; Transplantation, Homologous; Uremia

Two patients who developed reversible renal failure during intermittent rifampicin therapy are described. Both had febrile reactions to rifampicin. The first was also found to have uraemia associated with swelling of the glomerular endothelial cells. The second developed tubular necrosis unassociated with haemolysis or shock. The pathogenesis of the renal lesion in these two patients, as revealed by light microscopy, immunofluorescence studies and electron microscopy, is discussed.

Topics: Acute Kidney Injury; Adult; Antibodies; Endothelium; Ethambutol; Fever; Fibrin; Humans; Immune Complex Diseases; Ischemia; Kidney Glomerulus; Kidney Tubules; Male; Necrosis; Rifampin; Tuberculosis, Pulmonary; Uremia

Topics: Acute Kidney Injury; Age Factors; Anuria; Humans; Male; Middle Aged; Rifampin; Tuberculosis, Pulmonary; Uremia