AN UNCOMMON PRESENTATION OF RIFAMPICIN INDUCED ACUTE RENAL FAILURE

Department of TUBERCULOSIS AND CHEST DISEASES,MADRAS MEDICAL COLAbstract : Rifampicin induced Acute Renal Failure is uncommon and more frequently seen in intermittent therapy, occurs on reintroduction of Rifampicin in patients with history of previous Rifampicin regimen intake. Most frequent symptoms are gastrointestinal, flu-like and oliguria. But our case was non-oliguric. A 57 years old female on Catogery I Anti Tuberculous Treatment for TB Cervical Lymphadenitis presented with nausea, vomiting, heart burning and itching. HO prior ATT 20 years ago for Spinal Tuberculosis. Baseline Renal parameters were normal. Follow up Renal Function Tests revealed Acute Renal Failure. Renal biopsy revealed Acute Interstitial Nephritis—Rifampicin induced. ATT stopped. T.Prednisolone started with close monitoring of Renal function. Since patient was asymptomatic , non-oliguric Serum Creatinine was declining, patient was discharged and advised to continue non-Rifampicin based ATT regimen and to continue steroids for four weeks. A high index of suspicion for Rifampicin induced ARF should be considered in patients on ATT who present with symptoms of intolerance like nausea, vomiting and with progressive deterioration of Renal function. Diagnosis is based on circumstances, clinical presentation, Renal biopsy (Gold Standard). And baseline investigations are highly essential before starting ATT. Early diagnosis and discontinuation of Rifampicin are of fundamental importance for recovery of Renal function and there will be complete restoration of Renal function.