Korean Journal of Nephrology 1984;3(1):59-65.

Rifampin에 의한 급성 신부전증에서 백혈구 이주 억제검사 및 Methylprednislone 충격요법의 효과

이만영 , 전성주 , 최상덕 , 윤영석 , 이광우 , 김호연 , 방병기

Abstract

It haa been well defined that adverse reactions to rifampin is more common when the drug is given intermittently and later resumed. A single dose in then rapidly followed by hypersensitivity reaction including fever, nausea, vomiting, diarr- hea abdomina1 psin, petechiae, jaundice, thrombo- cytopenia and acute renal failure. Two casea are reported in whieh thrombobytop- enia and acute renal failure occurred during rea- dministration of rifampin one and eight years after first administration. I, Case I was a 50-year-old male who developed acute oliguric renal failure associated with throm- bocytopenic purpura and jaundice. He received eight months therapy with rifampin, INH and capremycin due to pumonary tubereulosis in 1975. 7 years later, in Sept. 1982, he took a single dose (300mg) of rifampin and then, 2 hrs later develo- ped fever, nausea, arthralgia, aMominal pain fo- llowed by acute oliguric renal,failure. Renal biopsy showed a finding of acute interatitial nephritis without immunoglobulin deposition on immunoflu- orescent studies. Leucocyte Migration Inhibitory Factor(LIF) test was carried out using patient's leucocyte and control serum drawn 2 hours after taking a single dose (6pp mg) of rifampin, but the result was negative. Almost total anuria lasted 12 days, and so methylpreddisolone pulse therapy (l. 0 mg) was given intravenously on 12 th and 1S th day after onset. Following pulse, immediate diuresis and rapid clinical improvement occurred. Case 2 was a 42 year old male who developed 2 times episodes of acute renal failure induced by rifampin. He received irregular 2 years therapy with INH, rifampin and stretomycin due to pulm- onary tuberuloeis from 1979 to 1981. In November 1982, he took 600 mg of rifampin for the second time and on the same day developed fever, nausea followed by oliguric renal fsilure. But thia time the definitive cause of acute renal failure waa not confirmed. Renal functional impairement rccovered eventually, but oliguria lasted 24 days and clinical recovery course prolonged to two months with con- servative management without steroid. In Sept. 1988, he took rifarnpin 600 mg for the S rd tima due to recurrent pulmonary tuberculosis and the :, same symptoms with acute renal failure occurred ' as praviously, Two doeea of methylprednisolone pulse therapy were given intravenously on 5 th ' and 6 th day after onaet. Thereafter immediate diureais and rapid improvement of renal functional deterirations were observed. He experienced only 5 daps oliguria and S weeke clinical recovery courae. It is conaidered that adverse reactions to rifam- picin can develop when the drug is resumed even in 8years interruption after first administration, and methylprednisolone may be effective for short- ening of oliguria and clinical recovery course.