Munteanu Liliana, Golea O, Nicolicioiu M, Tudorache V
Pneumologia. 2002 Jan-Mar;51(1):15-20.
This retrospective study was performed on 92 patients diagnosed with acute renal failure (ARF) post discontinuous rifampicin treatment, admitted between 1974-2000, in Hemodialysis Center of 1st Timisoara Clinical County Hospital. The passage from the continuous treatment (7/7) to discontinuous RMP treatment triggered the ARF in 77 patients and the restart of the treatment after one year or more of treatment arrest, lead to ARF in 15 cases. The ARF symptomatology appeared in the first 12 hrs of treatment resumption in 14.13% cases and in 85.87% after 38.5 +/- 8.2 hrs. The most frequent symptoms were lumbar pain in 76.08%, nausea and vomiting in 60.86%, abdominal pain (52.17% of cases) flu-like (fever, chills, myalgia), jaundice, diarrhea, hypotension, confusion and hypertension in only 7.6% of cases. In 94.56% of cases renal symptoms appeared in normal kidneys. The renal injury evolution was favorable, with significant improvements after 20 days in serum and urine biological parameters. The antibodies anti-RMP were present in serum 55.43% of patients, in 80.39% of them, the presence of antibodies was related to high values of gamma-globulins. In 33.69% of patients sterile leukocyturia, considered a marker of interstitial nephritis, was present. The most frequent associated ARF complications were the hemolytic anemia emphasized by high levels of unconjugated bilirubin and positive Coombs' test in 93.3% of patients, and liver injuries, present in 41.69% of cases. Thrombocytopenia was registered in 27.7% of cases, infections in 28.6%, gastrointestinal complications in 11.95%, and cardiovascular complications in 9.78% of cases, these severe forms leading to the death of patients. The ARF post discontinuous rifampicin treatment presents a favorable evolution even when it is associated with other organ or systems complications. The ARF and associated complications are due to the specific immune system activation by rifampicin, and by direct toxic effects of rifampicin at tissues level.
这项回顾性研究针对1974年至2000年间在蒂米什瓦拉第一临床县医院血液透析中心收治的92例间断性利福平治疗后诊断为急性肾衰竭（ARF）的患者进行。从连续治疗（每周7天）转为间断性利福平治疗致使77例患者发生ARF，而在治疗中断一年或更长时间后重新开始治疗，导致15例患者发生ARF。ARF症状在恢复治疗后的最初12小时内出现的占14.13%，在38.5±8.2小时后出现的占85.87%。最常见的症状为腰痛（76.08%）、恶心和呕吐（60.86%）、腹痛（52.17%的病例）、流感样症状（发热、寒战、肌痛）、黄疸、腹泻、低血压、意识模糊，高血压仅占7.6%的病例。94.56%的病例中肾脏症状出现在正常肾脏。肾脏损伤的演变情况良好，血清和尿液生物学参数在20天后有显著改善。55.43%的患者血清中存在抗利福平抗体，其中80.39%患者抗体的存在与γ-球蛋白的高值相关。33.69%的患者存在无菌性白细胞尿，这被视为间质性肾炎的一个标志物。最常见的ARF相关并发症为溶血性贫血，93.3%的患者表现为高未结合胆红素水平和库姆斯试验阳性，41.69%的病例存在肝损伤。27.7%的病例出现血小板减少，28.6%出现感染，11.95%出现胃肠道并发症，9.78%出现心血管并发症，这些严重情况导致患者死亡。间断性利福平治疗后的ARF即便伴有其他器官或系统并发症，其演变情况也较为良好。ARF及其相关并发症是由于利福平激活特异性免疫系统以及利福平在组织水平的直接毒性作用所致。
