A Case Series of Acute Kidney Injury During Anti-tuberculosis Treatment

Abstract

ObjectiveThe standard anti-tuberculosis (TB) regimen occasionally causes acute kidney injury (AKI). The major etiology is rifampicin-induced acute interstitial nephritis. However, the standard management of AKI induced by anti-TB drugs has yet to be established. Methods We retrospectively reviewed patients with TB who developed AKI after starting standard anti-TB treatment between 2006 and 2016 at a single TB center. The clinical characteristics and the management are described. Results Among 1,430 patients with active TB, 15 (1.01%) developed AKI. The mean age (standard deviation) was 61 years (18). The median (interquartile range) time to AKI development was 45 days (21-54 days). The median serum creatinine level before anti-TB treatment was 0.7 mg/dL (0.5-1.4 mg/dL), whereas the median peak serum creatinine level after AKI onset was 4.0 mg/dL (3.08-5.12 mg/dL). Five patients (33.3%) were pathologically confirmed as having acute interstitial nephritis (AIN), and 7 patients (46.7%) had a clinical diagnosis of the disease. All anti-TB drugs were stopped, and steroids were administered to 5 (100%) patients with pathologically confirmed AIN and 3 (42.8%) patients with clinically diagnosed AIN. The renal function was normalized in 12 patients (80.0%) after restarting anti-TB treatment without rifampicin (n=12) or isoniazid (n=1). Two patients died due to severe renal failure after restarting rifampicin. Conclusion Rifampicin is the leading cause of AKI. Levofloxacin may be an alternative to rifampicin thanks to its safety and potency. Restarting anti-TB treatment without rifampicin and short-term steroid administration may be a feasible management for AKI.

Incidence of and Risk Factors for Acute Kidney Injury During Antituberculosis Treatment: A Prospective Cohort Study and Literature Review

“…This is the first prospective study to investigate the risk of AKI among patients receiving anti-TB treatment by regularly monitoring their renal function; we report three major findings. First, the incidence of AKI during anti-TB treatment [13][14][15][16]20]. Four studies enrolled patients receiving anti-TB treatment [13][14][15]20], and two focused on patients receiving RIF [8,16].…”

“…First, the incidence of AKI during anti-TB treatment [13][14][15][16]20]. Four studies enrolled patients receiving anti-TB treatment [13][14][15]20], and two focused on patients receiving RIF [8,16]. The incidence of AKI in Romania [13], Japan [20], and Taiwan ranges from 0.05 to 10.4%.…”

Acute Tubular Necrosis and Thrombocytopenia Associated With Rifampin Use: Case Report and Review

“…A number of case series have also reported acute renal failure in the context of rifampin therapy [ 25–30 ]. One series reported 41 cases of biopsy-proven ATIN [ 27 ].…”

Acute tubulointerstitial nephritis due to the use of rifampicin. Case report

“…Although the patient was asymptomatic, ATIN diagnosis was achieved based on the findings in urine sediment, the temporal relationship with the administration of anti-tuberculous drugs, and the fact that rifampicin is the drug most associated with this pathology. (8,16) Some publications on this subject can be found in the literature. Chang et al (5), in a study conducted in Taiwan, studied acute kidney disease in patients treated with the four-drug tuberculosis regimen and found that it occurred in 7.1% of patients, of whom 11% developed the disease after first exposure to rifampicin.…”