Acquired Fanconi’s syndrome associated with tenofovir therapy

Mathew, George; Knaus, Stephen J.

doi:10.1111/j.1525-1497.2006.00518_1.x

Cited by 4 publications

(3 citation statements)

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“…13 There have also been several cases reported of Fanconi's syndrome in HIV patients treated with antinucleoside antiretrovirals. [14][15][16][17] Some mechanisms of drug-induced Fanconi's syndrome have been suggested. The multidrug-resistance-associated protein 2 (Mrp2) superfamily of transporters has been localized on the luminal membrane of proximal tubule cells.…”

Section: Discussionmentioning

confidence: 99%

Fanconi's Syndrome Associated with Prolonged Adefovir Dipivoxil Therapy in a Hepatitis B Virus Patient

Jung¹,

Yeon²,

Choi³

et al. 2010

Gut Liver

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Adefovir dipivoxil (ADV) is commonly used as an antiviral agent in the treatment of chronic hepatitis B or human immunodeficiency virus infection. Nephrotoxicity has been shown to occur at daily dosages of 60-120 mg. Fanconi's syndrome is a generalized dysfunction of the renal proximal tubular cells, which is usually accompanied by complications. Here we report a case of Fanconi's syndrome in a chronic hepatitis B patient who had been treated with a prolonged regimen of ADV at 10 mg/day. A 47-year-old man complained of severe back and chest-wall pain. He had chronic hepatitis B and had been treated with ADV at a daily dose of 10 mg for 38 months. He was hospitalized because of severe bone pain, and laboratory and radiologic findings suggested a diagnosis of Fanconi's syndrome with osteomalacia. After discontinuation of the ADV, he recovered and was discharged from hospital. His laboratory findings had normalized within 2 weeks. This case indicates that Fanconi's syndrome can be acquired by a chronic hepatitis B patient taking ADV at a conventional dosage of 10 mg/day. Therefore, patients treated with long-term ADV should be checked regularly for the occurrence of ADV-induced Fanconi's syndrome. (Gut Liver 2010;4:389-393)

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Section: Discussionmentioning

confidence: 99%

Fanconi's Syndrome Associated with Prolonged Adefovir Dipivoxil Therapy in a Hepatitis B Virus Patient

Jung¹,

Yeon²,

Choi³

et al. 2010

Gut Liver

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“…There have been rare cases of proximal renal tubular dysfunction, or Fanconi syndrome. This is characterized by glucosuria, hypophosphatemia, and renal tubular acidosis from diminished bicarbonate reabsorption [29]. Among patients with pre-existing renal insufficiency, long-term tenofovir is associated with nephrotoxicity and should be avoided [30].…”

Section: Tenofovir (Tdf)mentioning

confidence: 99%

A Review of the Toxicity of HIV Medications

et al. 2013

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Antiretroviral therapy has changed human immunodeficiency virus (HIV) infection from a near-certainly fatal illness to one that can be managed chronically. More patients are taking antiretroviral drugs (ARVs) for longer periods of time, which naturally results in more observed toxicity. Overdose with ARVs is not commonly reported. The most serious overdose outcomes have been reported in neonates who were inadvertently administered supratherapeutic doses of HIV prophylaxis medications. Typical ARV regimens include a "backbone" of two nucleoside reverse transcriptase inhibitors (NRTI) and a "base" of either a protease inhibitor (PI) or nonnucleoside reverse transcriptase inhibitor. New classes of drugs called entry inhibitors and integrase inhibitors have also emerged. Older NRTIs were associated with mitochondrial toxicity, but this is less common in the newer drugs, emtricitabine, lamivudine, and tenofovir. Mitochondrial toxicity results from NRTI inhibition of a mitochondrial DNA polymerase. Mitochondrial toxicity manifests as myopathy, neuropathy, hepatic failure, and lactic acidosis. Routine lactate assessment in asymptomatic patients is not indicated. Lactate concentration should be obtained in patients taking NRTIs who have fatigue, nausea, vomiting, or vague abdominal pain. Mitochondrial toxicity can be fatal and is treated by supportive care and discontinuing NRTIs. Metabolic cofactors like thiamine, carnitine, and riboflavin may be helpful in managing mitochondrial toxicity. Lipodystrophy describes changes in fat distribution and lipid metabolism that have been attributed to both PIs and NRTIs. Lipodystrophy consists of loss of fat around the face (lipoatrophy), increase in truncal fat, and hypertriglyceridemia. There is no specific treatment of lipodystrophy. Clinicians should be able to recognize effects of chronic toxicity of ARVs, especially mitochondrial toxicity.

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“…It was firstly reported by Lignae in 1924 and further defined by Fanconi in 1936 (8). In this syndrome, there is excessive excretion of glucose, bicarbonate, phosphate, uric acid, low molecular weight urinary proteins, potassium, sodium, and calcium, some amino acids, and also water from the urine due to abnormal proximal tubule reabsorption and 1α-hydroxylase dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Long-term adefovir therapy may induce Fanconi syndrome: A report of four cases

Fan

Wang

Zhang

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. Fanconi syndrome is a rare disease characterized by dysfunction of the proximal renal tubules as a result of various pathogenic events. Drug-induced Fanconi syndrome may be neglected or misdiagnosed, which increases the level of suffering. The aim of the present study was to conduct an investigation into the effects of adefovir (ADV)-induced Fanconi syndrome. Four typical cases of Fanconi syndrome caused by long-term ADV therapy (2-9 years) were diagnosed at our hospital. A complete medical and therapy history was collected from all four patients prior to a physical examination. Laboratory and diagnostic examinations were also conducted. Following this, the patients were diagnosed and a treatment regimen was decided upon. Outcomes of the treatment regimen were observed. Common manifestations of all the four patients were: Renal tubular reabsorption dysfunction; imbalanced electrolyte acid-base ratio; elevated cystatin C levels; severe hypophosphatemia and diffused systemic pain; osteoporosis; and difficultly walking. When ADV was replaced with supportive treatment, all the four patients exhibited symptom relief. These findings indicate that long-term ADV therapy may induce Fanconi syndrome. For patients with a history of such therapy, the possibility of Fanconi syndrome should be assessed and monitored closely for indicators, including altered glomerular and renal tubular function. Once diagnosed, the agent should be immediately discontinued and prompt symptomatic treatment should be administered.

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Acquired Fanconi’s syndrome associated with tenofovir therapy

Cited by 4 publications

References 0 publications

Fanconi's Syndrome Associated with Prolonged Adefovir Dipivoxil Therapy in a Hepatitis B Virus Patient

Fanconi's Syndrome Associated with Prolonged Adefovir Dipivoxil Therapy in a Hepatitis B Virus Patient

A Review of the Toxicity of HIV Medications

Long-term adefovir therapy may induce Fanconi syndrome: A report of four cases

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