title: Fanconi syndrome caused by antiepileptic therapy with valproic Acid.
abstract: OBJECTIVE
  Valproic acid (VPA) is commonly used as an antiepileptic drug (AED). Regular screening for renal side effects is uncommon. Fanconi syndrome, a generalized dysfunction of renal proximal tubular cells, occurs with some inborn errors of metabolism. In addition, it can be acquired by exposure to several toxic substances. We report a case of Fanconi syndrome after long-term therapy with VPA.
  
  
  METHODS
  An 8-year-old severely disabled and developmentally retarded boy with epilepsy was treated with VPA over a period of 7 years. He was hospitalized after a status epilepticus with laboratory findings suggesting a Fanconi syndrome. A PubMed-based worldwide review of the literature revealed that Fanconi syndrome is a rare side effect in children during long-term VPA treatment. We analyzed all 10 previously published cases by comparing age, underlying diseases, medication, and outcome.
  
  
  RESULTS
  Examination revealed metabolic acidosis suggestive of renal tubular malfunction. Based on typical clinical and laboratory findings, an acquired Fanconi syndrome was diagnosed. This was treated with large doses of sodium bicarbonate. After discontinuation of VPA, renal function completely normalized within 2 months.
  
  
  CONCLUSIONS
  Fanconi syndrome appears to be a rare but severe consequence of long-term VPA therapy. Therefore patients treated with VPA should be checked regularly for the possible development of VPA-induced Fanconi syndrome.
authors.affiliation: Department of General Pediatrics, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Knorr
authors.forename: Jörg
authors.initials: J
authors.lastname: Schaper
authors.forename: Malte
authors.initials: M
authors.lastname: Harjes
authors.forename: Ertan
authors.initials: E
authors.lastname: Mayatepek
authors.forename: Thorsten
authors.initials: T
authors.lastname: Rosenbaum
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D004827:Epilepsy / Q000188:drug therapy; D005198:Fanconi Syndrome / Q000139:chemically induced* / Q000000981:diagnostic imaging; D006225:Hand / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D011859:Radiography; D014635:Valproic Acid / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D014635:Valproic Acid