Acute Renal Failure due to Rifampicin Treatment

Dr. Cengiz Utas, Erciyes Universitesi Tip Fakültesi, Nefroloji Bilim Dali, 38039 Kayseri (Turkey) Dear Sir, In patients treated with rifampicin, acute renal failure may occur following influenzalike symptoms. Typical symptoms in these patients are chills, fever, lumbar pain, oligoa-nuria and hematuria. Serious side effects of rifampicin occur especially in patients on intermittent tuberculous therapy and irregular use of rifampicin [1-5]. We report 5 patients who developed acute renal failure following rifampicin intake. Case 1: Male, 54 years old, treatment with antituberculous drugs was initiated because of pulmonary tuberculosis. Three months later the therapy was ceased by himself. On feeling worse after 2 months without therapy, he again started to use rifampicin on his own accord. After 2 h of 300 mg rifampicin intake he had chills, fever, nausea and vomiting. He was admitted to our hospital for 60 h of oli-goanuria. On the fifth day 48-hour peritoneal dialysis therapy was performed because of acidosis. Polyuria was started on the 10th day and normal renal functions were achieved 8 weeks later. Case 2: Male, 19 years old, antituberculous therapy was started for pulmonary tuberculosis. At the end of the second month, intermittent therapy was initiated. In the 3rd week of the intermittent therapy he had complained of dizziness and nausea 20 min after taking the antituberculous drugs. He was admitted to the hospital, providing the emergency conditions 300 mg single dose of rifampicin were given orally and after 15 min nausea, vomiting, facial edema, fever dyspnea and hypotension occurred. Parenteral adrenaline, corticosteroids and antihistaminics were administered immediately and in 20-25 min the symptoms stabilized. Thirty-six hours of oliguria developed with acute impairment of renal function, polyuria started on the 4th day and 2 weeks later the renal function normalized without dialysis. Case 3: A 48-year-old woman who was taking antituberculous therapy because of miliary tuberculosis was admitted to the hospital in the second month of the intermittent therapy period for chills, fever, nausea, vomiting and lumbar pain a few hours after the intake of the drugs. The acute impairment of renal function without any oliguric state followed a full recovery in 3 weeks.