Severe Hypophosphatemic Osteomalacia with Fanconi Syndrome, Renal Tubular Acidosis, Vitamin D Deficiency and Primary Biliary Cirrhosis

Abstract

A 49-year-old

Tenofovir-Associated Severe Bone Pain: I Cannot Walk!

“…Laboratory reports supported the features of Fanconi syndrome in both cases with decreased plasma phosphorus and urine proteinuria. 11 The patients were taking different combinations of antiretroviral (ARV) medications at the time of presentation and none of their medications other than TDF are known to cause this syndrome. Laboratory changes demonstrated mild change in serum creatinine ( Figure 1A), a striking rise in alkaline phosphatase ( Figure 1B), a slow decrease in serum bicarbonate ( Figure 1C), and bone density loss ( Figure 2).…”

Osteomalacia with severe thoracic and spondylous deformity complicated by osteoporosis

“…These factors appeared to have contributed to the onset of osteomalacia and severe thoracic deformity. Previous reports have described osteomalacia with thoracic deformity,3 although the current case is rare as it was associated with severe respiratory insufficiency, caused by various different factors complicated by osteoporosis.…”

Hyponatremia and other electrolyte/ion disorders

“…More recently, hypophosphatemia has been described in 35% of alcoholics with alcoholrelated liver disease and in 29% of those without alcohol-related liver disease [77]. However, cases of severe or even life-threatening hypophosphatemia have been described in patients with cirrhosis due to other etiologies such as primary biliary cirrhosis [89] or virus-related cirrhosis [90]. The main causes of hypophosphatemia in patients with cirrhosis are reported in Table 18.4.…”

“…Hypophosphatemia and renal tubular function disappeared after 4 weeks of abstinence in alcoholic patients [77]. A reduced renal phosphate tubular reabsorptive capacity, as part of a more complex proximal tubular defect, is thought to be also the major determinant of hypophosphatemia either in patients with biliary cirrhosis [89] or in those with virus-related cirrhosis with jaundice [90]. Nevertheless, hypophosphatemia may be precipitated in patients with cirrhosis of any etiology or by infusion of glucose or amino acid solution or by refeeding or hyperalimentation.…”