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Hemoglobin Casts in Kidney Biopsies: Etiological Spectrum.

Indian J Nephrol

October 2022

Department of Pathology, Renopath, Center for Renal and Urological Pathology, Chennai, Tamil Nadu, India.

Intravascular hemolysis, which is the destruction of red blood cells in circulation, can cause acute kidney injury as the hemoglobin released by the lysed cells is toxic to the tubular epithelial cells. We performed a retrospective analysis of 56 cases of hemoglobin cast nephropathy reported at our institution to analyze the etiological spectrum causing this rare disease. The mean patient age was 41.

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We present a case of pulmonary tuberculosis treated with a rifampicin (RMP) containing regimen, which led to marked haemolysis and acute kidney injury. The patient was shown to have RMP-induced haemolysis on detailed immunological testing. RMP is described as a rare cause of drug-induced haemolysis in the literature.

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Background: Pigment nephropathy represents one of the most severe complications of rhabdomyolysis or hemolysis.

Methods: We performed a retrospective observational study to analyze the etiology, clinical manifestation, laboratory profile and outcome in patients with biopsy-proven pigment-induced nephropathy between January 2011 and December 2016. History, clinical examination findings, laboratory investigations and outcome were recorded.

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Rifampicin is a key component of multidrug regimens not only for tuberculosis, but also nontuberculous mycobacterial infections (NTM) which are on the rise worldwide. Knowledge of the toxicity profile is important. Hepatotoxicity is a well-known side effect of Rifampicin necessitating regular liver function monitoring during therapy.

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