Rifampicin
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Rifampicin Haemolysis leading to haemoglobin cast nephropathy and acute kidney injury: case report
A 64-year-old woman developed haemolysis leading to haemoglobin cast nephropathy and acute kidney injury (AKI) during treatment with rifampicin for recurrent pulmonary mycobacterium avium complex infection [route, dosage and duration of treatment to reactions onsets not stated]. The woman presented to a hospital with the complaints of nausea and vomiting over 3 days. Three years prior to the presetation, she was diagnosed with pulmonary mycobacterium avium complex infection and had received rifampicin [rifampin], ethambutol and azithromycin at that time. Two months prior to the current presentation, she was diagnosed with recurrent pulmonary mycobacterium avium complex infection, and again started receiving rifampicin, ethambutol and azithromycin. After a few days, she developed back pain, nausea, vomiting, fever and chills. At current presentation, she was afebrile and alert on physical examination. She had no other distress except three new small purpuric lesions on her back. Her BP was 153/82mm Hg, heart rate was 54 beats/min, respiratory rate was 18 breaths/min and oxygen saturation was 97% on room air. Investigations showed low platelet count, with elevated serum creatinine and lactate dehydrogenase levels. Based on further investigations, a concern for the possibility of thrombotic thrombocytopenic purpura was raised, and she was started on plasma exchange. However, ADAMTS13 was found to be normal, excluding thrombotic thrombocytopenic purpura; hence, plasma exchange was discontinued. The woman’s therapy with rifampicin was discontinued on hospitalisation. No schistocytes were found in the peripheral blood smear. A rifampicin-induced platelet-reactive antibody was identified. On day 4 of hospitalisation, serum creatinine level increased further but her platelet count had improved. Due to concern of rifampicin associated acute interstitial nephritis, she was started on methylprednisolone for 3 days. She underwent haemodialysis, and then kidney biopsy. The findings of kidney biopsy and other investigations confirmed the diagnosis of haemolysis leading to haemoglobin cast nephropathy. The presence of mild interstitial oedema with a few scattered inflammatory cells, indicated a possibility of acute interstitial nephritis prior to the start of methylprednisolone. However, no persistent interstitial nephritis was noted. The haemolysis and haemoglobin casts were considered as the causes of AKI. She continued on supportive care, and her kidney function improved gradually. She was then discharged. Four weeks after the discharge, a further improvement in serum creatinine level was noted. Mahmud S, et al. Hemoglobin Cast Nephropathy. Kidney International Reports 5: 1581-1585, No. 9, Sep 2020. Available from: URL: http://doi.org/10.1016/ j.ekir.2020.06.019
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Reactions 3 Oct 2020 No. 1824
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