Arellano-Contreras D, Carmona-Guzmán C

Language: Spanish
References: 9
Page: 116-119
PDF size: 823.96 Kb.

ABSTRACT

40-years-old male with Human Immunodeficiency Virus (HIV) undertaking retroviral treatment of embricitabine/tenofovir disoproxil fumarate (TDF/FTC) and lopinavir/ritonavir (LOP/r) since 2007. The patient attends the appointment without any important findings after the exploration. However, displays the following alterations on the laboratory tests: hyperchloremic metabolic acidosis with anion gap (AG), elevated urine anion gap (urinary AG), normoglycaemic glycosuria, proteinuria, low HCO₃, low PO₄, all findings consistent with fanconi syndrome. An ultrasonogram showed undetermined nephropathy and a biopsy spots chronic tubulo-interstitial nephritis with secondary glomerular damage. The fanconi syndrome is a generalized defect of the proximal re-absorption and the transportation of aminoacids, glucose, phosphate, uric acid, Na, K, HCO₃, low molecular weight, secondary to basolateral membrane damage of Na active transportation. It may be idiopathic, secondary to systemic diseases or the use of medications. The clinical presentation includes a wide range of alterations in the laboratory exams that may be accompanied by entities such as rachitism, osteomalacia or osteoporosis. As for the glomerular damage for the use of TDF, there is evidence of physiological mechanisms. Nevertheless, the etiology is still considered as multifactorial.

REFERENCES

1. Panel on Antiretroviral Guidelines for Adults and Adolescents, Department of Health and Human Services. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. 2011; 1–166.

2. Izzedine H, Launay-Vacher V et al. Drug-induced Fanconi's syndrome. Am J Kidney Dis 2003. 41: 292-309.

3. Quinn KJ, Emerson CR et al. Incidence of proximal renal tubular dysfunction in patients on tenofovir disoproxil fumarate. Int J STD AIDS. 2010. 21: 150-151.

4. Woodward CLN, Hall M, Williams IG, Madge S, Copas A, Nair D et al. Tenofovir-associated renal and bone toxicity. 2009. HIV medicine. 10: 482-487.

5. Brenner and Rector's. Capítulo 40. Inherited Disorders Associated with Generalized Dysfunction of the proximal Tubule (Renal Fanconi Syndrome), publicado en el libro The Kidney. 8va edición. Editorial Saunders Elsevier. Volumen 1. pag: 1390.

6. Samir Kg. Tenofovir-Associated Fanconi Syndrome: Review of the FDA Adverse Event Reporting System. 2007. AIDS patiente care STDS. 22(2): 99-103.

7. Herlitz LC, Mohan S et al. Tenofovir nephrotoxicity: acute tubular necrosis with distinctive clinical, pathological, and mitochondrial abnormalities. Kidney Int. 2010; 78(11): 1171-1177.

8. Andrew M. Hall, Bruce M. Hendry et al. Tenofovir-Associated Kidney Toxicity in HIV-Infected Patients: A Review of the Evidence. Am J Kidney Dis. 2011. 57(5):773-780.

9. Fernández B, Montoya A et al. Tenofovir Nephrotoxicity: 2011 Update. AIDS Research and Treatment. 2011. (11)