Acquired Fanconi's Syndrome Associated with Tenofovir Therapy

Abstract

Tenofovir (Viread s) is a nucleotide reverse transcriptase inhibitor introduced into the United States in 2001. It is frequently prescribed not only for its efficacy but also for its decreased side effect profile compared with other nucleoside analogs. It is now increasingly recognized as a cause of acquired Fanconi's syndrome (FS) in human immunodeficient individuals. We describe a case of a patient with AIDS, who, after starting tenofovir therapy, developed myalgias, renal failure, and profound electrolyte abnormalities compatible with the classic features of FS. On discontinuation of tenofovir and replacement of electrolytes, the individual improved clinically with normalization of his renal failure and electrolyte abnormalities. With the success of tenofovir in the anti-HIV drug market, practitioners should remain alert to the possibility of the development of FS. Frequent urine, renal, and electrolyte parameters should be measured at regular intervals following initiation of tenofovir therapy.

Proximal Tubule Function and Free Water Clearance: Comparison between Healthy Elderly and Young HIV+ Patients

“…Conversely, our HIV patients were not on any hyponatremia inducing drugs, concomitant diseases, nor suffering from AIDS. Besides, even though they were on tenofovir, which can induce proximal tubule damage, this renal function was preserved in our volunteers as it was documented by Chaimovitz test's results and their pre-test renal screening [12,13]: normal serum and urine electrolytes values, urinalysis and kidney ultrasound. Thus, as long as we know, this is the first study that has described a urine diluting incapability in stable HIV patients.…”

Tenofovir-Associated Severe Bone Pain: I Cannot Walk!

“…1 Like its derivatives adefovir and cidofovir, 2,3 TDF has been linked to sporadic Fanconi syndrome, renal failure, and bone mineral density (BMD) loss. [4][5][6][7][8][9][10] We recently cared for 2 HIV-1-infected adult males on highly active antiretroviral therapy (HAART) that included TDF, who presented with the inability to walk due to severe bone pain. One had no change in serum creatinine whereas the other had an only a slight elevation.…”

Concomitant AIDS cholangiopathy and Fanconi syndrome as complications of HIV in a single patient

“…Initially described by Lignac in 1924 and then Fanconi in 1936,1 Fanconi syndrome (FS) is characterised by a defect in proximal renal tubular function, leading to aminoaciduria, hypophosphataemia, hypokalaemia and hyperchloraemia 2. This leads to a clinical picture of polyuria, polydipsia and glycosuria in the presence of normal serum glucose, as well as rickets (children) or osteomalacia (adults).…”