RIFAMPICIN-ASSOCIATED ACUTE-RENAL-FAILURE - PATHOPHYSIOLOGIC, IMMUNOLOGICAL, 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 hemo lytic anemia and acute renal failure (ARF) necessitating dialysis. We demonstrated the presence in the patient's serum of rifampicin-depende nt immunoglobulin G (IgG) and IgM antibodies, which caused red blood c ell lysis through interaction with the I antigen on the erythrocyte su rface. A review of the literature yielded 48 cases of rifampicin-assoc iated renal failure. A subgroup of 37 patients could be distinguished, which, analogous to our case, suddenly developed ARF and frequently a lso developed hemolytic anemia and/or thrombocytopenia during intermit tent or interrupted treatment. Regarding the pathogenesis of the ARF, renal biopsy consistently revealed tubular lesions. Although intravasc ular hemolysis with hemoglobinuria may play a role, it is not uniforml y present. Our demonstration of an antibody with anti-I specificity pr ovides a possible explanation. The I antigen is also expressed on tubu lar epithelium and may, therefore, be the target structure through whi ch rifampicin-antibody complexes lead to tubular cell destruction. The other cases of rifampicin-associated ARF were unrelated to this subgr oup: two cases of rapidly progressive glomerulonephritis, five cases o f acute interstitial nephritis, and four cases of light chain proteinu ria were recorded. (C) 1998 by the National Kidney Foundation, Inc.