Rifampicin-associated acute renal failure: pathophysiologic, immunologic, and clinical features.
A 71-year-old woman was treated for a relapsing pulmonary tuberculosis with reinstitution of rifampicin after a medication-free interval of 2 years. After ingestion of the second dose, she developed severe hemolytic anemia and acute renal failure (ARF) necessitating dialysis. We demonstrated the presence in the patient's serum of rifampicin-dependent immunoglobulin G (IgG) and IgM antibodies, which caused red blood cell lysis through interaction with the I antigen on the erythrocyte surface. A review of the literature yielded 48 cases of rifampicin-associated renal failure. A subgroup of 37 patients could be distinguished, which, analogous to our case, suddenly developed ARF and frequently also developed hemolytic anemia and/or thrombocytopenia during intermittent or interrupted treatment. Regarding the pathogenesis of the ARF, renal biopsy consistently revealed tubular lesions. Although intravascular hemolysis with hemoglobinuria may play a role, it is not uniformly present. Our demonstration of an antibody with anti-I specificity provides a possible explanation. The I antigen is also expressed on tubular epithelium and may, therefore, be the target structure through which rifampicin-antibody complexes lead to tubular cell destruction. The other cases of rifampicin-associated ARF were unrelated to this subgroup: two cases of rapidly progressive glomerulonephritis, five cases of acute interstitial nephritis, and four cases of light chain proteinuria were recorded.
De Vriese
A S
AS
Department of Internal Medicine, University Hospital, Gent, Belgium. an.devriese@rug.ec.be
Robbrecht
D L
DL
Vanholder
R C
RC
Vogelaers
D P
DP
Lameire
N H
NH
D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology / Q000276:immunology / Q000503:physiopathology; D000368:Aged; D000743:Anemia, Hemolytic / Q000139:chemically induced / Q000453:epidemiology / Q000276:immunology / Q000503:physiopathology; D000904:Antibiotics, Antitubercular / Q000009:adverse effects* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D012293:Rifampin / Q000009:adverse effects* / Q000627:therapeutic use; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy
D000904:Antibiotics, Antitubercular; D012293:Rifampin