Avaliação de marcadores de lesão do túbulo proximal renal e incidência de redução da filtração glomerular em pacientes portadores de Hepatite B em uso de tenofovir

Laurindo, Alan Fernandes

doi:10.11606/d.17.2016.tde-06012016-112948

Cited by 1 publication

(2 citation statements)

References 65 publications

(88 reference statements)

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“…As in the study by Laurindo (2015) [31], also in our series, NGAL was not superior to the other renal biomarkers for the diagnosis of tubular dysfunction. It is important to mention that in our study, the median of NGAL was superior in the control group than in HBV-HIV These evidences, combined with its higher cost and technical complexity, does not make NGAL a priority alternative in daily clinical practice for screening tubular dysfunction.…”

Section: Discussionsupporting

confidence: 70%

“…Therefore, the contribution of tubular dysfunction after prolonged use of TDF to the gradual impairment of renal function does not appear to be significant, according to the literature [26,40,41]. Progressive chronic kidney disease in this context tends to be sporadic [27,28,30,31] and generally associated with factors that are usually predisposing to it, such as cardiovascular disease, diabetes , dyslipidemia and hypertension. Even HBV infection itself represents a possible additional factor for kidney damage, especially due to the glomerular deposition of immune complexes [42].…”

Section: Discussionmentioning

confidence: 99%

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Renal dysfunction during treatment of chronic hepatitis B with tenofovir disoproxyl fumarate and associated risk factors

Maciel,

Ferraz,

Perez

et al. 2024

European Journal of Gastroenterology &Amp; Hepatology

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Objectives To analyze the evolution of glomerular filtration rate (GFR) and the presence of renal tubular dysfunction during the treatment of chronic hepatitis B virus (HBV) infection with tenofovir disoproxil fumarate (TDF) and to determine the risk factors involved. Methods Retrospective cohort observational study of adults with chronic hepatitis B. Exclusion: hepatitis C virus-HBV coinfection, diabetes, baseline GFR less than 60 ml/min. Measurements of serum and urinary creatinine and phosphate; urinary albumin, retinol-binding protein (RBP) and neutrophil gelatinase-associated lipocalin (NGAL) were performed. Univariate and multivariate analyses tracked factors associated with worsening GFR. Results A total of 120 individuals were included: 35% NAÏVE (G1); 49.2% HBV using TDF (G2); 15.8% HBV-HIV using TDF (G3); 63.3% men; 60.8% white; 30% hypertensive. Average age was 50.5 years (SD ± 12.9 years). Reactive HBeAg predominated in G3 (P < 0.001) and cirrhosis in G2 (P < 0.036). NGAL was elevated in 5.3% of cases (G1 = 3.2%; G2 = 8.7%; G3 = 0%; P = 0.582), RBP in 6.7% (G1, G3 = 0%; G2 = 13.6%; P = 0.012), urinary phosphate/creatinine ratio in 16.2% (G1 = 15.2%; G2 = 14.5%; G3 = 23.5%; P = 0.842) and urinary albumin/creatinine ratio in 12.9% (G1 = 12.2%; G2 = 10.7%; G3 = 21.1%; P = 0.494). Worsening of renal function occurred in 22.5% of the population (G1 = 11.9%; G2 = 28.8%; G3 = 26.3%; P = 0.122), independently associated only with systemic arterial hypertension [adjusted odds ratio (AOR) = 4.14; P = 0.008], but not to TDF (AOR = 2.66; P = 0.110) or male sex (AOR = 2.39; P = 0.135). However, the concomitance of these variables generated a high estimated risk for this outcome (51%). Conclusions Renal tubular dysfunction was uncommon according to NGAL, RBP or urinary phosphate/creatinine ratio. TDF was not an independent factor for worsening renal function, significantly associated only with systemic arterial hypertension. However, in hypertensive men, the use of TDF should be monitored.

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Section: Discussionsupporting

confidence: 70%