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. 2019 Feb 15;58(4):521-527.
doi: 10.2169/internalmedicine.0813-18. Epub 2018 Oct 17.

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

Kentaro Sakashita  1   2 , Kengo Murata  1 , Yukiko Takahashi  3 , Miake Yamamoto  1 , Kana Oohashi  1 , Yu Sato  1 , Miyako Kitazono  1 , Akihiko Wada  1 , Mikio Takamori  1
Affiliations

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

Kentaro Sakashita et al. Intern Med. .

Abstract

Objective The standard anti-tuberculosis (TB) regimen occasionally causes acute kidney injury (AKI). The major etiology is rifampicin-induced acute interstitial nephritis. However, the standard management of AKI induced by anti-TB drugs has yet to be established. Methods We retrospectively reviewed patients with TB who developed AKI after starting standard anti-TB treatment between 2006 and 2016 at a single TB center. The clinical characteristics and the management are described. Results Among 1,430 patients with active TB, 15 (1.01%) developed AKI. The mean age (standard deviation) was 61 years (18). The median (interquartile range) time to AKI development was 45 days (21-54 days). The median serum creatinine level before anti-TB treatment was 0.7 mg/dL (0.5-1.4 mg/dL), whereas the median peak serum creatinine level after AKI onset was 4.0 mg/dL (3.08-5.12 mg/dL). Five patients (33.3%) were pathologically confirmed as having acute interstitial nephritis (AIN), and 7 patients (46.7%) had a clinical diagnosis of the disease. All anti-TB drugs were stopped, and steroids were administered to 5 (100%) patients with pathologically confirmed AIN and 3 (42.8%) patients with clinically diagnosed AIN. The renal function was normalized in 12 patients (80.0%) after restarting anti-TB treatment without rifampicin (n=12) or isoniazid (n=1). Two patients died due to severe renal failure after restarting rifampicin. Conclusion Rifampicin is the leading cause of AKI. Levofloxacin may be an alternative to rifampicin thanks to its safety and potency. Restarting anti-TB treatment without rifampicin and short-term steroid administration may be a feasible management for AKI.

Keywords: acute interstitial nephritis; acute kidney injury; rifampicin.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Serum creatinine levels in the pretreatment phase, AKI onset phase, and poorest renal function phase (n=15). The chronic phase comprised data from 13 patients who survived after developing AKI. *Patients who died.
Figure 2.
Figure 2.
Time to the onset of acute kidney injury (n=15).
See this image and copyright information in PMC

Comment in

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