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

Abstract

Introduction: Acute kidney injury (AKI) is occasionally detected in patients receiving antituberculosis (TB) treatment. This prospective cohort study is the first to investigate the incidence, risk factors, and renal outcomes of AKI during anti-TB treatment. Methods: This study was conducted from January 1, 2016, to May 31, 2018. Patients with a new diagnosis of TB and on standard anti-TB treatment were enrolled, and the patients received regular laboratory monitoring. AKI was defined according to the Kidney Disease: Improving Global Outcome (KDIGO) criteria. Urinalysis, renal ultrasonography, blood erythrocyte morphology, and fractional excretion of sodium were performed at AKI onset. The TB treatment regimen was adjusted by the primary physician if necessary. Risk factors for AKI were identified through Cox regression.Results: In total, 106 patients were recruited (mean age 52.6 years, 71.7% men). Eleven (10.3%) patients experienced AKI. Increased serum uric acid and hemoglobin levels were noted at AKI onset. All patients with AKI achieved renal recovery and completed anti-TB treatment containing rifampin. Age [hazard ratio (HR) 1.06 (1.02-1.11)], a higher baseline estimated glomerular filtration rate [eGFR; HR 1.04 (1.02-1.06)], and a blood eosinophil count[350 (10 9 /L) )] were associated with a higher risk of AKI during TB treatment. Conclusion: Regular pharmacovigilant monitoring revealed an incidence of renal impairment during anti-TB treatment that was higher than expected. AKI was more common in older patients with a higher eGFR and blood eosinophil count. However, the complications had no influence on TB treatment completion, and no permanent renal impairment occurred.

Rifampicin‐induced acute tubulointerstitial nephritis during pulmonary tuberculosis treatment: A case report

“…This percentage is higher than reported in previous retrospective studies (0.05%-7.1%). 1 RIF-induced AKI usually occurs in patients who have previously taken this drug or who are undergoing intermittent treatment. 2,3 It is assumed that previous or intermittent exposure to RIF triggers an immune response.…”

“…4 When a biopsy is performed, ATIN and acute tubular necrosis are the most common histopathological findings during RIF-induced AKI. 1 The kidney biopsy is the gold standard for the diagnosis of ATIN. 5 In cases where renal biopsy is contraindicated or not feasible, The diagnosis can be based on a compatible clinical course and laboratory findings.…”

“…Tubulointerstitial nephritis is an uncommon complication in patients on anti‐TB therapy. It can lead to permanent kidney damage 1 . Although RIF is the most frequently involved drug in this complication, other first‐line anti‐TB drugs, such as INH, ETB, and PYZ were also associated with AKI 1–5 .…”

“…It can lead to permanent kidney damage 1 . Although RIF is the most frequently involved drug in this complication, other first‐line anti‐TB drugs, such as INH, ETB, and PYZ were also associated with AKI 1–5 . In a prospective study, the incidence of AKI during anti‐TB treatment was 10.3%.…”

“…Tuberculosis (TB) is a global health problem that accounted for 1.5 million deaths in 2020 1 . Prompt treatment remains the most effective intervention to control the spread of the disease.…”