Anti Tuberculous Therapy Induced Acute Kidney Injury- A Case Report

Anti- Tuberculous Therapy (ATT) is a combination of drugs used to treat tuberculosis, with Rifampicin forming the bedrock of therapy. It is a bactericidal drug with a relatively safe side effect profile. We present the case of a lady in her 50s, treated for Pulmonary tuberculosis 15 years ago, who came with complaints of hemoptysis x 5 episodes, loss of weight and appetite for 2 weeks. She was clinically diagnosed to have a tuberculosis reactivation and was empirically started on ATT, 5 days following which she developed pedal edema and decreased urine output. She was diagnosed to have an acute kidney injury (AKI) and initiated on dialysis. A renal biopsy was taken to identify the cause for renal failure and it revealed an acute tubular injury with pigment casts, probably secondary to intravascular hemolysis induced by Rifampicin. This case highlights the importance for physicians, especially in countries with a high tuberculosis burden, to have a good understanding of the adverse reactions associated with the use of ATT, no matter how uncommon they may be. This will facilitate faster recognition and more effective management of these patients, resulting in less long-term morbidity for these patients.