Tenofovir induced Fanconi syndrome: A possible pharmacokinetic interaction

Abstract

Tenofovir was introduced as a second line drug for the treatment of human immunodeficiency virus (HIV) infection in India in December 2009. Although rare, renal toxicity is a recognized adverse drug reaction (ADR) of this drug, especially when administered with boosted lopinavir-ritonavir. In this case, an HIV positive patient receiving tenofovir based antiretroviral therapy (ART) for last 1 year developed albuminuria, glycosuria and hypophosphatemia. Renal function tests and random blood sugar were within normal limits. He was diagnosed as a case of tenofovir induced Fanconi syndrome. Tenofovir was discontinued and patient was prescribed an alternate regimen. Five months later clinical symptoms and renal functions returned to normal. A pharmacokinetic interaction between tenofovir and ritonavir may have resulted in the toxicity. A periodic monitoring of renal functions is desirable in patients on tenofovir based ART.

Fanconi syndrome, diabetes insipidus, and acute kidney injury due to tenofovir disoproxil fumarate: A case report

“…This presentation is similar to prior published cases. 10–12 Nephrogenic diabetes insipidus was probable with the patient’s hypernatraemia and dehydration, evidenced by clinical exam and hemoconcentration on laboratory studies. Furthermore, there was no use of diuretics, history of poor access to water intake with insensible losses, or any reason to suspect central diabetes insipidus.…”

“…[3][4][5][6][7] The cases reviewed make it clear that discontinuation of the drug is paramount and usually leads to overall improvement in all aspects of renal function. [3][4][5][6][7][10][11][12] Although our patient's baseline renal function wasn't recorded, it can be assumed that her renal impairment was attributed to the effects of tenofovir as it improved substantially after the treatment was discontinued. Several studies have shown that TDF is associated with either AKI or chronic kidney disease through proximal tubal injury, either tubular necrosis or interstitial nephritis.…”

“…3–7 The cases reviewed make it clear that discontinuation of the drug is paramount and usually leads to overall improvement in all aspects of renal function. 3–7,10–12…”

“…Cases reported in the literature reveal that most patients present with weakness and myalgia and laboratory studies indicate hypophosphatemia, hypokalemia, metabolic acidosis, and normoglycemic glycosuria. [4][5][6][7][10][11][12] Fanconi syndrome can be inherited or acquired. The inherited subtype is usually diagnosed in childhood.…”

Microwave Assisted, One Pot Synthesis of Alkyl-3-amino-2-arylimino-1,3-thiazolan-4-ones-5-ylidene Acetate

“…The synthesis of the thiazolidin-4-one scafold is gaining considrable attention due to the fact that its derivatives have shown a wide spectrum of activities. Thiazolidine-4-ones are important building blocks in pharmaceutical agent and biologically active products [1][2][3][4][5] . Several substituted thiazolidinones have been found to possess hypnotic, anaesthetic, sedative, anticonvulsant and microbiological activities [6][7][8][9] .…”