Minimal change nephrotic syndrome associated with rifampicin treatment

Abstract

Rifampicin is a commonly used anti‐tuberculosis agent which has been reported to have some adverse effects, including nephrotoxicity [1–9]. The most frequent form of nephrotoxicity is a syndrome consisting of acute renal failure, with tubular necrosis as pathological finding, with or without haemolysis and thrombocytopenia, generally occurring during intermittent or interrupted treatment. Other forms of nephrotoxicity are interstitial nephritis with or without mild glomerular lesions, rapidly progressive glomerulonephritis and light chain proteinuria [3]. We herein report a case of minimal change nephrotic syndrome (MCNS) after rifampicin treatment which was not associated with acute interstitial nephritis or any other glomerular lesion, followed by complete remission after discontinuation of rifampicin. A 43‐year‐old female was admitted to the hospital for further evaluation of a right pleural abnormality detected on a chest X‐ray film. She had a history of allergy to penicillin. On admission, her body temperature was 36.5°C, and the blood pressure was 116/70 mmHg. Physical examination was unremarkable. Urinalysis did not reveal any abnormalities. Laboratory investigation showed: haemoglobin 12.7 g/dl, haematocrit 39.6%, blood urea nitrogen (BUN) 13.1 mg/dl, serum creatinine 0.9 mg/dl, Na 141 mEq/l, K 3.9 mEq/l, total protein 8.4 g/dl, albumin 3.9 g/dl, total cholesterol 170 mg/dl. A chest X‐ray showed pleural thickening of the right lung. Bronchoalveolar lavage showed no acid‐fast bacilli, but PPD (purified protein derivative of tuberculin) skin test showed a positive reaction. Pleural tuberculosis was suspected and antituberculous treatment was started with rifampicin 450 mg/day, isoniazid 300 mg/day and ethambutol hydrochloride 750 mg/day.