Renal tubular dysfunction associated with tenofovir therapy: report of 7 cases.
We describe 7 cases of renal tubular injury in HIV-infected patients receiving an antiretroviral regimen containing tenofovir. Our patients (5 women and 2 men) developed renal tubular dysfunction, with hypophosphatemia, normoglycemic glycosuria, proteinuria, and decrease of creatinine clearance. The first biologic signs of renal toxicity were observed after duration of tenofovir treatment from 5 weeks to 16 months, and they resolved less than 4 months after discontinuation of tenofovir. Six patients had a low body weight (<60 kg). Five patients received low doses of ritonavir, and 1 received didanosine. In 5 patients, the signs resolved with the discontinuation of only the tenofovir. A renal biopsy performed in 1 patient was consistent with tubulointerstitial injury. Proximal tubulopathy appears to be a rare adverse effect of long-term tenofovir therapy. In patients with low weight or mild preexisting renal impairment, regular monitoring of tubulopathy markers could lead to early detection of this dysfunction.
Peyrière
Hélène
H
Department of Medical Pharmacology, Lapeyronie Hospital, CHU Montpellier, France.
Reynes
Jacques
J
Rouanet
Isabelle
I
Daniel
Nathalie
N
de Boever
Corinne Merle
CM
Mauboussin
Jean-Marc
JM
Leray
Hélène
H
Moachon
Laurence
L
Vincent
Denis
D
Salmon-Céron
Dominique
D
D000225:Adenine / Q000009:adverse effects* / Q000031:analogs & derivatives*; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects*; D001835:Body Weight; D004359:Drug Therapy, Combination; D005260:Female; D006029:Glycosuria / Q000139:chemically induced; D006801:Humans; D017674:Hypophosphatemia / Q000139:chemically induced; D007684:Kidney Tubules / Q000187:drug effects / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates; D009943:Organophosphorus Compounds / Q000009:adverse effects*; D011507:Proteinuria / Q000139:chemically induced; D000068698:Tenofovir; D016896:Treatment Outcome
D019380:Anti-HIV Agents; D063065:Organophosphonates; D009943:Organophosphorus Compounds; D000068698:Tenofovir; D000225:Adenine