Sanwal Chandra, Kaldas Amber, Surani Salim, Bailey Michael
Internal Medicine, Corpus Christi Medical Center, Corpus Christi, USA.
Internal Medicine, University of North Texas, Dallas, USA.
Cureus. 2020 Jul 10;12(7):e9120. doi: 10.7759/cureus.9120.
Rifampin-induced acute kidney injury is very rare. Most cases of acute renal injury from rifampin use are related to acute tubular necrosis and acute interstitial nephritis. In this case report, we detail a unique presentation of rifampin-associated acute intravascular hemolysis and subsequent tubular injury in a tuberculosis patient. The patient had presented to the hospital with acute kidney injury and oliguria from intravascular volume depletion secondary to intractable vomiting. The patient had stopped taking his antituberculosis medications two weeks before hospitalization. At the time of hospital admission, his antituberculosis regimen of rifampin and isoniazid was reinstituted. Within four days of initiation of rifampin, he developed acute hemolytic anemia. His kidney biopsy revealed hemoglobin pigment deposition in the kidney tubules. Rifampin was discontinued, and he received a total of eight hemodialysis treatments spanning over 17 days. Subsequently, after discontinuing rifampin, his anemia and oliguria resolved with renal function markedly improved to near normal baseline levels. This case report also offers a review of known mechanisms of rifampin-induced acute hemolysis and acute renal failure, along with a discussion of contemporary literature.
利福平所致急性肾损伤非常罕见。大多数因使用利福平导致的急性肾损伤病例与急性肾小管坏死和急性间质性肾炎有关。在本病例报告中，我们详细描述了一名结核病患者中利福平相关的急性血管内溶血及随后的肾小管损伤的独特表现。该患者因顽固性呕吐继发血管内容量耗竭而出现急性肾损伤和少尿，前来医院就诊。患者在住院前两周停止服用抗结核药物。入院时，重新开始使用利福平及异烟肼的抗结核治疗方案。在开始使用利福平的四天内，他出现了急性溶血性贫血。其肾脏活检显示肾小管中有血红蛋白色素沉积。停用利福平后，他总共接受了17天内的8次血液透析治疗。随后，停用利福平后，他的贫血和少尿症状消失，肾功能明显改善至接近正常基线水平。本病例报告还对利福平所致急性溶血和急性肾衰竭的已知机制进行了综述，并对当代文献进行了讨论。
