Rifampicin-associated intravascular haemolysis causing acute kidney injury

Drug-induced acute kidney injury (AKI) is a rare adverse effect of rifampicin, and is mostly related to acute tubular necrosis and acute interstitial nephritis. We report a sputum- positive, isoniazid mono-resistant, pulmonary tuberculosis patient who had a history of anti-tuberculous therapy (ATT) intake 30 years ago. The patient developed AKI requiring dialysis when he restarted the ATT recently. A renal biopsy was consistent with pigment-cast nephropathy secondary to rifampicin-induced intravascular haemolysis. Rifampicin was stopped, and the patient underwent a total of four dialysis sessions and subsequently recovered.