Yonsei Med J.  2015 Mar;56(2):582-585. 10.3349/ymj.2015.56.2.582.

Rifampicin-Induced Minimal Change Disease Is Improved after Cessation of Rifampicin without Steroid Therapy

• Park DH
• Lee SA
• Jeong HJ
• Yoo TH
• Kang SW
• Oh HJ

• KMID: 2070042
• DOI: http://doi.org/10.3349/ymj.2015.56.2.582

Abstract

There are several reports to demonstrate that rifampicin, a major anti-tuberculosis agent, is associated with some adverse renal effects, with a few cases of rifampicin-induced minimal change disease (MCD). In the present case, a 68-year-old female presented with nausea, vomiting, foamy urine, general weakness and edema. She had been taking rifampicin for 4 weeks due to pleural tuberculosis. The patient had no proteinuria before the anti-tuberculosis agents were started, but urine tests upon admission showed heavy proteinuria with a 24-h urinary protein of 9.2 g/day, and serum creatinine, albumin, and total cholesterol levels were 1.36 mg/dL, 2.40 g/dL, and 283 mg/dL, respectively. MCD was diagnosed, and the patient achieved complete remission after cessation of rifampicin without undergoing steroid therapy.

Keyword

Minimal change disease; rifampicin; steroid

MeSH Terms

Aged
Antibiotics, Antitubercular/*adverse effects/therapeutic use
Edema/etiology
Female
Humans
Kidney Function Tests
Kidney Glomerulus/pathology
Nausea/etiology
Nephrosis, Lipoid/*chemically induced/pathology
Proteinuria
Remission Induction
Rifampin/*adverse effects/therapeutic use
Treatment Outcome
Tuberculosis, Pleural/*drug therapy
Antibiotics, Antitubercular
Rifampin

Figure

• 

  Fig. 1 (A) Light microscopy shows minor abnormalities of the glomeruli. The tubules show minimal atrophy and mild focal tubular injury. The interstitium is widened by minimal fibrosis. Non-sclerotic glomeruli are normocellular without mesangial expansion (H&E staining). (B) Electron microscopy shows diffusely effaced foot processes. The glomerular basement membranes are relatively even, but focal thinning of the lamina densa is noted. The mesangium is not expanded and is free of electron-dense deposits (H&E staining).

• 

  Fig. 2 Clinical course. After discontinuation of rifampicin, the UPCr was recovered. UPCr, random urine protein-to-creatinine ratio.

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