Acute interstitial nephritis of HIV-positive patients under atazanavir and tenofovir therapy in a retrospective analysis of kidney biopsies

Abstract

We performed a retrospective analysis on kidney biopsies of 30 human immunodeficiency virus (HIV)-positive patients. Twenty-two of them received highly active antiretroviral therapy (HAART). Tenofovir containing HAART together with atazanavir, a new protease inhibitor, was administered to three patients. All of them developed acute renal failure. The kidney biopsies of these patients showed an acute interstitial nephritis or a chronic interstitial nephritis with an acute component. Withdrawal of atazanavir and tenofovir resulted in recovery of renal function in all three patients. Acute interstitial nephritis was observed only in 1 of 19 patients without atazanavir or tenofovir treatment. We conclude that acute interstitial nephritis and consecutive acute renal failure is a relevant side effect of atazanavir and tenofovir therapy in HIV-positive patients.

Impact of a tenofovir disoproxil fumarate plus ritonavir-boosted protease inhibitor-based regimen on renal function in HIV-infected individuals: a prospective, multicenter study

“…Previous case reports reported TDF-associated renal toxicity, including acute tubular necrosis [6], Fanconi syndrome [7-9], and ultimately, renal failure [10] characterized by a decline in glomerular filtration rates (GFRs) and hypophosphatemia [11,12]. Studies with primarily Caucasian patients report low rates of tenofovir-associated nephrotoxicity, and severe renal impairment is rare in clinical trials of tenofovir-containing first line antiretroviral therapy (ART) regimens [13,14].…”

Drug-Induced Acute Interstitial Nephritis Mimicking Acute Tubular Necrosis after Initiation of Tenofovir-Containing Antiretroviral Therapy in Patient with HIV-1 Infection

“…Tenofovir was highly likely the causative drug, because sulfamethoxazole/trimethoprim, the other drug which was used just before the occurrence of AIN, had been intermittently used for more than two months before the introduction of ART without any complications. To our knowledge, this is the fourth reported case of tenofovir-induced AIN, in addition to the three cases reported by Schmid et al (6). Nevertheless, it is difficult to entirely role out the involvement of sulfamethoxazole/trimethoprim in occurrence of this AIN case.…”

Diffuse Tubulointerstitial Nephritis Accompanied by Renal Crystal Formation in an HIV-infected Patient Undergoing Highly Active Antiretroviral Therapy

“…Therefore, there was a possibility that the TDF nephrotoxity was enhanced by the use of Ritonavir in the current patient. A recent study has evaluated the renal injuries in kidney biopsies of 30 HIV patients undergoing ATV therapy (23). TIN was found in six patients and the combination of ATV and TDF was noted in three of them.…”