Kidney Week

Abstract: SA-PO293

Rapid Loss of Kidney Function Associated with the Use of Capreomycin

Session Information

• Trainee Case Reports - VI
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Reports

• 1903 CKD (Non-Dialysis): Mechanisms

Authors

• Gouveia, Rafaela Magalhães leal, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil

Rafaela Magalhães leal Gouveia,

• Netto, Moacir Coutinho, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil

Moacir Coutinho Netto,

• Gueiros, Ana Paula, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil

Ana Paula Gueiros,

• Meira, Mirna Duarte, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil

Mirna Duarte Meira,

• Cabral, Cidcley Nascimento, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil

Cidcley Nascimento Cabral,

• Mello, Heliana Morato Lins e, IMIP, Recife, Brazil

Heliana Morato Lins e Mello,

Introduction

Capreomycin (CPM) is used in the treatment of resistant forms of tuberculosis (TB), resulting in the adverse effect of nephrotoxicity. In the acute forms, tubular necrosis or glomerular alteration occurs, which is reversible if the use of the drug is suspended. Chronic impairment is characterized by interstitial nephritis. We report the case of a patient who developed severe renal dysfunction associated with the use of CPM.

Case Description

Male (aged 65), diabetes mellitus (DM) for 4 years, diagnosed with pulmonary TB (positive smear microscopy), initiated treatment with Rifampicin (RFP), Isoniazid, Pyrazinamide (PZA) and Etambutol (ETB). After 9 months, he remained symptomatic and GeneXpert detected resistance to RFP. In June 2017, he initiated treatment with CPM, ETB, Levofloxacin, Terizidone and PZA. At this time, he presented with creatinine (Cr mg/dL) 0.58 and hemoglobin (Hb g/dL) 13. After 6 months on the new treatment, he presented with Cr 2.5. In the ninth month, with negative sputum culture and undetectable GeneXpert, CPM and PZA were suspended, as recommended by the Brazilian Ministry of Health. In the tenth month, Cr was 2.64 and Hb 8.2, and the dosage of the other medications was adjusted according to the glomerular filtration rate (GFR). Although CPM was suspended, the patient evolved with no improvement in the GFR, with Cr 2.46, an absence of proteinuria, hematuria or leukocyturia and proteinuria/24h 162mg. He presented a normal kidney ultrasound and a fundoscopy with non-proliferative diabetic retinopathy. Renal biopsy: normal glomeruli, no mesangial, endo or extracapillary proliferation, necrosis, sclerosis or thickening of the basement membrane; mild atrophy and interstitial fibrosis, with interstitial mononuclear infiltrate and arterial segment with mild fibro-intimal hyperplasia. Immunofluorescence did not demonstrate immunocomplexes.

Discussion

This case demonstrates a rapid, severe alteration of the GFR in a diabetic, normotensive patient with no evident proteinuria. The biopsy did not reveal kidney impairment from the DM. The literature reports few cases on nephrotoxicity from CPM. This study emphasizes the importance of strict controlling the GFR in patients on CPM, especially the elderly and those with comorbidities.