Misdiagnosis of Bone Metastasis Cancer After Using Adefovir Dipivoxi in a Hepatitis B Patient with Fanconi Syndrome

Li, Xin; Shen, Man; Sun, Wei; Huang, Zhongxia; An, Na; Zhang, Jiajia

doi:10.1007/s12288-015-0501-x

Cited by 4 publications

(4 citation statements)

References 11 publications

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“…However, awareness of this condition seems unsatisfactory in daily clinical practice, since some patients with ADV-induced Fanconi syndrome have been undiagnosed or even misdiagnosed. Li et al (20) reported a 41-year-old man with an 8-year history of low-dose ADV therapy for HBV. He had suffered from chest wall pain and lower limb weakness over a six-month period.…”

Section: Discussionmentioning

confidence: 99%

Hypophosphatemic Osteomalacia Associated with Adefovir-induced Fanconi Syndrome Initially Diagnosed as Diabetic Kidney Disease and Vitamin D Deficiency

et al. 2019

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A 68-year-old man with type 2 diabetes mellitus and chronic hepatitis B infection was referred to the nephrology department before planned surgery for hepatocellular carcinoma. He had been receiving low-dose adefovir dipivoxil (ADV) for 11 years. Laboratory findings revealed impaired re-absorption in the proximal renal tubules. He had been diagnosed with diabetic kidney disease and osteomalacia due to vitamin D deficiency; thus, ADV was not discontinued until he was referred to us. In this case, concomitant diabetes mellitus and vitamin D deficiency might have prevented the early diagnosis of ADV-induced Fanconi syndrome.

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Section: Discussionmentioning

confidence: 99%

Hypophosphatemic Osteomalacia Associated with Adefovir-induced Fanconi Syndrome Initially Diagnosed as Diabetic Kidney Disease and Vitamin D Deficiency

et al. 2019

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“…Therefore, early detection of abnormalities in chemical examinations and early diagnosis are particularly important for timely alleviation of patients' pain. Since Fanconi syndrome is rare, numerous physicians are unfamiliar with its symptoms and signs, thus leading to delayed diagnosis and treatment (9). Therefore, improved knowledge of Fanconi syndrome is important, particularly for hepatologists.…”

Section: Discussionmentioning

confidence: 99%

“…Compared with other nucleoside analogs, adefovir dipivoxil is characterized by low cost, low drug resistance and absence of cross-resistance, and has been applied widely in developing countries (4,5). However, renal toxicity is the most common adverse reaction associated with adefovir dipivoxil, and it has been reported to cause Fanconi syndrome (6)(7)(8), which is often misdiagnosed due to a dearth of knowledge among the majority of clinicians (9). In addition, some common manifestations of Fanconi syndrome, including systemic bone pain, osteoporosis and spontaneous fracture, are easily misdiagnosed as osteoarthrosis, osteoporosis and bone tumors in the early stages (9,10).…”

Section: Introductionmentioning

confidence: 99%

Adefovir dipivoxil-induced Fanconi syndrome and its predictive factors: A study of 28 cases

et al. 2016

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Abstract. The aim of the present study was to identify monitoring and prevention measures as well as predictive factors for early detection of renal toxicity associated with long-term administration of adefovir dipivoxil in order to avoid progression to Fanconi syndrome. Clinical data of 28 patients with Fanconi syndrome caused by long-term administration of adefovir dipivoxil for the treatment of chronic hepatitis B virus (HBV) infection were collected pre-and post-administration for analysis. Patients presented with fatigue, progressive systemic pain in multiple bones and joints, as well as difficulty in walking and pathological fractures in a number of severe cases. Laboratory examinations revealed hypophosphatemia, elevated serum cystatin C (Cys-C), elevated serum creatinine (SCr), reduced glomerular filtration rate (GFR), positive urinary protein, erythrocytes and glucose, as well as osteoporosis. In consequence, adefovir dipivoxil administration was stopped, and patients received concentrated divitamins, sodium phosphate syrup and calcitriol. Symptoms and abnormalities in laboratory examinations were significantly improved in all patients after 2-6 months. Therefore, serum phosphate, SCr, routine urine parameters, Cys-C and GFR should be monitored regularly in chronic HBV patients treated with adefovir dipivoxil. The following factors were identified as predictive of kidney damage and Fanconi syndrome: Age ≥40 years, living in rural areas, previous renal toxicity, estimated GFR (eGFR) <90 ml/min/1.73 m 2 , hypertension, diabetes, cirrhosis and duration of adefovir dipivoxil treatment exceeding 24 months. The present results indicate that timely termination of adefovir dipivoxil treatment and replacement with other antiviral agents is critical once renal impairment appears, and that it is necessary to change to other antiviral agents and prolong the interval of administration according to the eGFR level.

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“…The main characteristics of 32 patients with ADV-induced FS, including eight patients in our institution and 24 published cases, are summarized in Table 4 . 5 , 18 , 22 , 23 , 36 – 43 …”

Section: Reviewmentioning

confidence: 99%

Fanconi syndrome induced by adefovir dipivoxil: a case report and clinical review

et al. 2020

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More than 150 cases of Fanconi syndrome (FS) or hypophosphatemia osteomalacia induced by low-dose adefovir dipivoxil (ADV) have been reported since 2002, when ADV was introduced for the long-term treatment of hepatitis B virus (HBV) infection. Because the life expectancy of HBV-infected individuals has increased, the adverse effects of long-term treatment with antiviral therapies are increasingly observed, and nephrotoxicity is one of the most severe adverse effects of ADV. Therefore, the number of cases may be far higher than reported. Moreover, ADV-induced FS is often misdiagnosed or diagnosed long after it first develops. ADV-induced FS may seriously decrease patient quality of life and lead to bone fractures and even disability. Although progress has been made in the identification of biomarkers and treatments, few systematic clinical guidelines or clinical reviews for FS induced by ADV have been reported. In this study, we highlighted the recent progress toward understanding of FS induced by ADV, described a clinical case, and summarized the primary characteristics and laboratory findings of this disease.

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Misdiagnosis of Bone Metastasis Cancer After Using Adefovir Dipivoxi in a Hepatitis B Patient with Fanconi Syndrome

Cited by 4 publications

References 11 publications

Hypophosphatemic Osteomalacia Associated with Adefovir-induced Fanconi Syndrome Initially Diagnosed as Diabetic Kidney Disease and Vitamin D Deficiency

Hypophosphatemic Osteomalacia Associated with Adefovir-induced Fanconi Syndrome Initially Diagnosed as Diabetic Kidney Disease and Vitamin D Deficiency

Adefovir dipivoxil-induced Fanconi syndrome and its predictive factors: A study of 28 cases

Fanconi syndrome induced by adefovir dipivoxil: a case report and clinical review

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