Rifampin-Induced Acute Intravascular Hemolysis Leading to Heme Pigment-Related Kidney Injury

Abstract

Rifampin-induced acute kidney injury is very rare. Most cases of acute renal injury from rifampin use are related to acute tubular necrosis and acute interstitial nephritis. In this case report, we detail a unique presentation of rifampin-associated acute intravascular hemolysis and subsequent tubular injury in a tuberculosis patient. The patient had presented to the hospital with acute kidney injury and oliguria from intravascular volume depletion secondary to intractable vomiting. The patient had stopped taking his antituberculosis medications two weeks before hospitalization. At the time of hospital admission, his antituberculosis regimen of rifampin and isoniazid was reinstituted. Within four days of initiation of rifampin, he developed acute hemolytic anemia. His kidney biopsy revealed hemoglobin pigment deposition in the kidney tubules. Rifampin was discontinued, and he received a total of eight hemodialysis treatments spanning over 17 days. Subsequently, after discontinuing rifampin, his anemia and oliguria resolved with renal function markedly improved to near normal baseline levels. This case report also offers a review of known mechanisms of rifampin-induced acute hemolysis and acute renal failure, along with a discussion of contemporary literature.

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

“…Since that review was published, there have been 22 case reports of presumed rifampin-induced acute renal failure with renal biopsy findings (summarized in Table 1 ) [ 3–24 ]. Of these 22 cases, the majority were being treated for tuberculosis, and the majority occurred in males (17/21; 77%).…”

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

“…7,[10][11][12][13] The Literature review reveals that most patients with rifampicin-induced AKI might also develop concomitant hemolytic anemia. 4 The definition of rifampin-associated AKI varies in different studies, and the exact incidence rate remains unknown. One review article from Romania reports that 0.05% of patients receiving rifampicin (mean age, 45 years) developed AKI, which was defined as elevated serum creatinine >44.2 μmol/L or > 20% of baseline in 2 weeks.…”

“…Although reported multiple times, there are insufficient data to determine which patients are prone to renal failure post‐rifampicin use and how to manage this adverse reaction. It is noted that patients taking rifampicin also may develop hemolysis, with or without renal injury 4 . This article will review a rare case report of kidney failure associated with hemolytic anemia and hepatitis following first‐time administration of rifampicin and a literature review of similar articles.…”

“…It is noted that patients taking rifampicin also may develop hemolysis, with or without renal injury. 4 This article will review a rare case report of kidney failure associated with hemolytic anemia and hepatitis following first-time administration of rifampicin and a literature review of similar articles.…”

Anemia Hemolítica Induzida Por Medicamento: Uma Revisão Sistemática

“…Outro destaque consiste na possibilidade do desenvolvimento de reações imunoalérgicas, como a anemia hemolítica, relacionadas à rifampicina, comum no uso irregular deste medicamento no aguda associada e lesão tubular subsequente devido a deposição de hemoglobina nos túbulos renais 18 .…”