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

Abstract

The Author Replies We appreciate Dr. Fukuchi and colleagues for their prompt comment on our article. We describe the details of the two patients who died. One patient was referred to our hospital because his acute kidney injury (AKI) relapsed after Rifampicin (RIF) desensitization in a previous hospital. His renal function did not improve despite stopping all anti-tuberculosis (TB) drugs and administering steroids. When the patient was transferred to our hospital, his blood pressure was <80 mmHg, and he had severe delirium. We sedated him and started continuous renal replacement therapy (CRRT). However, the patient could not tolerate CRRT due to his unstable vital signs and continuing delirium. In addition, he developed massive pleural effusion and generalized edema. The patient finally developed severe bacterial pneumonia and died of respiratory failure three days after his referral to our hospital. Therefore, we were unable to restart the anti-TB drugs. The other patient was over 80 years old and developed AKI after Isoniazid, RIF and Ethambutol administration. The patient had severe malnutrition when diagnosed with active pulmonary TB. We stopped all anti-TB drugs and administered steroids. After his renal function improved, we started RIF desensitization. However, his AKI relapsed only a short while later. The patient's general condition did not recover, and he became continuously bedridden. He finally developed aspiration pneumonia and acute respiratory distress syndrome. His ultimate cause of death was respiratory failure. The author states that he has no Conflict of Interest (COI).

Rifampin‐induced acute kidney injury and hemolysis: A case report and literature review of a rare condition

“…36% of patients reviewed in the articles required dialysis (Table 3). Additionally, a good proportion of patients responded well to steroids, the median starting steroid dose was 50 mg (range: 40–50 mg), and the median duration of steroid administration was 52 days 20 . These studies show a complete recovery of kidney function after treatment in most patients with an excellent long‐term prognosis 7,8 .…”

Antitubercular Drug induced Hepatitis: An Adverse Drug Reaction

“…The first line agents for Anti TB treatment are four drugs Isoniazid, Rifampicin, Pyrizinamide and Ethambutol among which Isoniazid, Rifampicin and Pyrizinamide are primarily metabolized by liver therefore these drugs from the main cause of hepatotoxicity in case of drug induced hepatotoxicity during anti TB treatment. 8 The risk factors for Anti TB drug induced hepatotoxicity are as follows geriatric patients, female gender, under nourishment, Ethanolic, history of liver diseases, lung parenchymal and HIV infection. However, the exact mechanism of biochemical reaction and pathogenesis of Anti TB drug induced hepatotoxicity remains uncertain.…”

“…However, the exact mechanism of biochemical reaction and pathogenesis of Anti TB drug induced hepatotoxicity remains uncertain. 8 Liver is an important body organ according to physiological point of view as it is responsible for metabolism of many xenobiotics. The incidence of hepatotoxicity is 2.6% with combination of Isoniazid and Rifampicin, 1.1% with Rifampicin monotherapy and 1.6% with isoniazid monotherapy.…”

A Risk Prediction Model for Acute Kidney Injury in Pulmonary Tuberculosis Patients during Anti-tuberculosis Treatment

“…Whereas, approximately 27% of AKI patients will develop permanent kidney damage [8]. Even more importantly, AKI is generally asymptomatic, so screening and prediction for kidney injury during anti-TB treatment are particularly important.…”