title: Rifampin-associated tubulointersititial nephritis and Fanconi syndrome presenting as hypokalemic paralysis.
abstract: BACKGROUND
  Rifampin is one of the most important drugs in first-line therapies for tuberculosis. The renal toxicity of rifampin has been reported sporadically and acute tubulointerstitial nephritis (ATIN) is a frequent histological finding. We describe for the first time a case of ATIN and Fanconi syndrome presenting as hypokalemic paralysis, associated with the use of rifampin.
  
  
  METHODS
  A 42-year-old man was admitted with sudden-onset lower extremity paralysis and mild renal insufficiency. He had been treated for pulmonary tuberculosis with isoniazid, rifampin, and ethambutol for 2 months. Laboratory tests revealed proteinuria, profound hypokalemia, hyperchloremic metabolic acidosis with a normal anion gap, positive urine anion gap, hypophosphatemia with hyperphosphaturia, hypouricemia with hyperuricosuria, glycosuria with normal serum glucose level, generalized aminoaciduria, and β2-microglobulinuria. A kidney biopsy revealed findings typical of ATIN and focal granular deposits of immunoglubulin A and complement 3 in the glomeruli and tubules. Electron microscopy showed epithelial foot process effacement and electron-dense deposits in the subendothelial and mesangial spaces. Cessation of rifampin resolved the patient's clinical presentation of Fanconi syndrome, and improved his renal function and proteinuria.
  
  
  CONCLUSIONS
  This case demonstrates that rifampin therapy can be associated with Fanconi syndrome presenting as hypokalemic paralysis, which is a manifestation of ATIN. Kidney function and the markers of proximal tubular injury should be carefully monitored in patients receiving rifampin.
authors: Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea.
authors: Hong Ki
authors: HK
authors: Min
authors: Eun Oh
authors: EO
authors: Kim
authors: Sang Ju
authors: SJ
authors: Lee
authors: Yoon Kyung
authors: YK
authors: Chang
authors: Kwang Sun
authors: KS
authors: Suh
authors: Chul Woo
authors: CW
authors: Yang
authors: Suk Young
authors: SY
authors: Kim
authors: Hyeon Seok
authors: HS
authors: Hwang
mesh_terms: D000328:Adult; D000904:Antibiotics, Antitubercular / Q000008:administration & dosage; D003937:Diagnosis, Differential; D005198:Fanconi Syndrome / Q000139:chemically induced* / Q000175:diagnosis; D006801:Humans; D007008:Hypokalemia / Q000139:chemically induced* / Q000175:diagnosis*; D008297:Male; D009395:Nephritis, Interstitial / Q000139:chemically induced* / Q000175:diagnosis; D010243:Paralysis / Q000139:chemically induced* / Q000175:diagnosis; D012293:Rifampin / Q000008:administration & dosage*
chemical_list: D000904:Antibiotics, Antitubercular; D012293:Rifampin