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      Minimal change disease related to rifampicin presenting with acute renal failure during treatment for latent tuberculosis infection : A case report

      , MD a , , MD, PhD b , , MD, PhD a ,


      Wolters Kluwer Health

      acute renal failure, dialysis, isoniazid, minimal change disease, rifampicin

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          The standard drugs used to treat tuberculosis are rifampicin and isoniazid. These agents are usually safe and inexpensive for short-term use in treatment of latent tuberculosis infection, but sometimes cause adverse renal effects, including minimal change disease (MCD).

          Patient concerns:

          Here, we report a 51-year-old woman with latent tuberculosis infection who developed nephrotic syndrome during treatment with rifampicin and isoniazid for 25 days.


          Renal biopsy findings were compatible with MCD, and she had no relevant medical history and was not taking other medications. A diagnosis of anti-tuberculosis drug- induced MCD was made. This is the first report of acute renal failure due to rifampicin and/or isoniazid-induced MCD.


          After cessation of rifampicin and isoniazid, however, acute renal failure progressed and she was treated with temporary dialysis and oral prednisolone.


          The patient achieved complete remission after cessation of rifampicin and isoniazid with steroid therapy.


          This case demonstrates that rifampicin and/or isoniazid can cause nephrotic syndrome with acute renal failure during the first months of continuous latent tuberculosis therapy. Therefore, renal function and proteinuria should be monitored carefully in all patients taking rifampicin and isoniazid, especially during the first few months of therapy.

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          Most cited references 14

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          Adult minimal-change disease: clinical characteristics, treatment, and outcomes.

          Minimal-change disease (MCD) counts for 10 to 15% of cases of primary nephrotic syndrome in adults. Few series have examined this disease in adults. A retrospective review was performed of 95 adults who had MCD and were seen at a single referral center. Examined were presenting features, response to daily versus alternate-day steroids, response to second-line agents, relapse patterns, complications of the disease and therapy, presence of acute renal failure (ARF), and outcome data. Sixty-five patients received daily and 23 received alternate-day steroids initially. There were no differences in remissions, time to remission, relapse rate, or time to relapse between daily- and alternate-day-treated patients. More than one quarter of patients were steroid resistant. At least one relapse occurred in 73% of patients; 28% were frequently relapsing. A significant proportion of frequently relapsing patients became steroid dependent. Second-line agents were used for steroid dependence, steroid resistance, or frequent relapses. No single agent proved superior. There were more remissions with second-line agents in steroid-dependent patients compared with steroid-resistant patients, and remissions were more likely to be complete in steroid-dependent patients. ARF occurred in 24 patients; they tended to be older and hypertensive with lower serum albumin and more proteinuria than those without ARF. At follow up, patients with an episode of ARF had higher serum creatinine than those without ARF. Four patients progressed to ESRD. These patients were less likely to have responded to steroids and more likely to have FSGS on repeat renal biopsy. In this referral MCD population, response to daily and alternate-day steroids is similar. Second-line agents give greater response in patients who are steroid dependent. ARF occurs in a significant number of adult MCD patients and may leave residual renal dysfunction. Few patients progress to ESRD.
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            Steroid responsiveness and frequency of relapse in adult-onset minimal change nephrotic syndrome.

            To clarify factors influencing the response to corticosteroids and subsequent relapses, 62 Japanese adult patients with minimal change nephrotic syndrome were analyzed retrospectively. Five patients experienced remission spontaneously. Fifty-three patients entered complete remission, 3 patients entered partial remission, and 1 patient showed no response to corticosteroids. Fifty-three patients with complete remission were divided into two groups: 38 early responders who experienced remission completely within 8 weeks after starting treatment and 15 late responders who experienced remission after 8 weeks. Blood urea nitrogen and serum creatinine levels and proteinuria selectivity index at presentation were significantly worse in late than early responders. Relative interstitial volume determined by the point-counting method was significantly greater in late than early responders. Relative interstitial volume showed significant correlations with blood urea nitrogen, serum creatinine, and proteinuria selectivity index values. Thirty-three patients experienced a relapse; 13 patients experienced multiple relapses. Fifty-three patients with remission were divided into three groups: 16 patients who experienced relapse within 6 months after the initial response (early relapsers), 17 patients who experienced relapse after 6 months (late relapsers), and 20 patients who did not experience relapse (nonrelapsers). Mean age at onset was younger in early relapsers than late or nonrelapsers. Age at onset correlated inversely with relapse rate in 53 patients with remission and correlated positively with timing of the first relapse in 33 relapsers. It thus was suggested that impaired renal function and poor selectivity of proteinuria, which might be related to interstitial edema, were factors influencing a slower response to corticosteroids. Younger patients had a greater incidence of relapse and were prone to experience relapse earlier. Copyright 2002 by the National Kidney Foundation, Inc.
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              Acute renal failure due to rifampicin: a study of 25 patients.

              Acute renal failure (ARF) caused by rifampicin typically occurs on intermittent administration. There are isolated case reports and only one series reported in the literature. Systematic data, especially from countries endemic for tuberculosis and leprosy, are sparse. We studied demographic, clinical, biochemical, and histopathologic features and prognosis of 25 consecutive patients with rifampicin-associated ARF admitted from July 1990 to June 2000. Rifampicin-associated ARF constituted 2.5% of all cases of ARF seen during the study period. The most common pattern of drug intake resulting in ARF (40%) was ingestion of a single dose preceded by a drug-free period (range, 10 days to 6 years) after a course of daily rifampicin (range, 8 days to 18 months). Onset was with gastrointestinal and flu-like symptoms 4 hours (median) after drug intake. All patients were oliguric. Anemia and thrombocytopenia each occurred in 60% of patients. Acute hepatitis was present in 32%. Among 12 patients who underwent kidney biopsy, 7 patients (58%) had acute interstitial nephritis (AIN). Crescentic glomerulonephritis was seen in 1 patient, and mesangial proliferation, in 3 patients. No single feature at presentation predicted the severity of renal failure. There were no deaths, and all patients recovered renal function. Patients with rifampicin-associated ARF were oliguric and presented with gastrointestinal and flu-like symptoms, typically after reintroduction of the drug after a drug-free period. Anemia and thrombocytopenia were common. AIN was the most common biopsy finding. No factor predicted severity, but the renal prognosis was good. Copyright 2002 by the National Kidney Foundation, Inc.

                Author and article information

                Medicine (Baltimore)
                Medicine (Baltimore)
                Wolters Kluwer Health
                June 2018
                01 June 2018
                : 97
                : 22
                [a ]Department of Internal Medicine, Yeungnam University Medical Center
                [b ]Department of Pathology, Yeungnam University Medical Center, Daegu, Republic of Korea.
                Author notes
                []Correspondence: Eun-Young Choi, Department of Internal Medicine, College of Medicine, Yeungnam University Medical Center, Yeungnam University, 170 Hyeonchung-ro, Namgu, Daegu 705-703, Republic of Korea (e-mail: letact@ 123456hanmail.net ).
                MD-D-17-07989 10556
                Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

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