Rifampin-induced acute kidney injury is quite rare. rifampin, his anemia and oliguria solved with renal function improved to near normal baseline amounts markedly. This case record also offers an assessment of known systems of rifampin-induced severe hemolysis and severe renal failure, plus a dialogue R112 of contemporary books. strong course=”kwd-title” Keywords: severe tubular necrosis, severe interstitial nephritis, immune system hemolytic anemia, rifampin, hemolysis, drug-induced severe renal failure Intro Drugs had been first suspected like a reason behind immune-hemolytic anemia (IHA) in 1953 . Drug-induced thrombocytopenia can be more prevalent than drug-induced immune-hemolytic anemia (DIIHA). There is certainly great data for the occurrence of drug-induced thrombocytopenia (10-18 instances per million) and neutropenia (2-15 instances per million) but just crude estimations for DIIHA around one per million of the populace. In comparison to DIIHA, autoimmune hemolytic anemia (AIHA) prevalence can be higher and it is apparently one per hundred thousand of the populace. The amount of medicines causing DIIHA offers improved from 15 known medicines in 1967 to a moderate amount of 125 this year 2010. DIIHA can be due to IgM or IgG antibodies and appears TXNIP to have no romantic relationship to other allergies (e.g., anaphylaxis), that are connected with IgE antibodies  usually. Inside a scholarly research by Mayer et al., among 73 individuals with drug-induced hemolytic anemia, the most frequent single medicines identified had been diclofenac, piperacillin, ceftriaxone, and oxaliplatin . Rifampin can be trusted in multidrug regimens for the treating tuberculosis (TB) and nontuberculous mycobacterial attacks, and is known as a highly effective antistaphylococcal agent also. Hepatitis, thrombocytopenia, cutaneous symptoms, flu symptoms, abdominal symptoms, respiratory symptoms, orange-colored urine, as well as disseminated intravascular coagulation (DIC) are a number of the known unwanted effects of rifampin [3-5]. Rifampin-associated severe renal failing (RARF) can be a problem of anti-TB treatment happening in less than 0.1% of patients with TB . Rifampin treatment regimens are classified as continuous, with a daily intake of a rifampin dose; intermittent, with ingestion of a dose one, two, three, or five times weekly; and interrupted, when therapy is resumed after a course of daily or intermittent treatment and a subsequent drug-free interval . In any case, it is widely accepted R112 that the vast majority of RARF events are due to intermittent or interrupted rifampin use, for instance, in patients with previous drug exposure or poor compliers [6-8]. However, cases of RARF after continuous use of rifampin have been also reported [6,7]. There are multiple mechanisms of RARF: acute tubular necrosis (ATN), acute interstitial nephritis (AIN), rapidly progressive glomerulonephritis (RPGN), and light chain proteinuria. ATN from rifampin use can happen from heme pigment deposition due to intravascular hemolysis alone or from direct renal tubular damage [7,9]. Our case report is a rare presentation of RARF due to rifampin use in the interrupted manner, due to heme pigment deposition in R112 renal tubules R112 from intravascular hemolysis. Case presentation The patient is a 49-year-old Vietnamese male with a past medical history of latent TB and non-insulin-dependent diabetes mellitus type 2. He presented with nausea, vomiting, and progressively decreasing urine output for one week. The patient described his urine color dark brown like Coca-Cola. R112 He had associated symptoms of generalized weakness and lower back pain. About two months before the current presentation, he was admitted to the hospital for pneumonia and diagnosed with latent TB. Chest CT at that time revealed multifocal pulmonary nodules or nodular consolidations widely distributed throughout each lung area. The consolidations were largest in the perihilar portion of the right lung and throughout the dependent portion of the left lung base that.