Tenofovir-related acute kidney injury and proximal tubule dysfunction precipitated by diclofenac: a case of drug-drug interaction.
We describe an HIV1-positive patient under long-term tenofovir treatment who developed a severe, biopsy-proven, acute tubular necrosis with proximal tubule (PT) dysfunction, precipitated by the very recent start of diclofenac, a nonsteroidal antiinflammatory drug (NSAID). Recent studies show that NSAIDs not only alter glomerular filtration but also multidrug resistance protein (MRP) 4-mediated PT secretion of several substrates. Since the patient tolerated tenofovir well for several years prior to diclofenac use, our observation suggests that diclofenac interfered with tenofovir clearance, thereby favoring its nephrotoxicity. NSAIDs should be avoided in patients under tenofovir.
Morelle
J
J
Department of Nephrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
Labriola
L
L
Lambert
M
M
Cosyns
J-P
JP
Jouret
F
F
Jadoul
M
M
D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000473:pathology; D000225:Adenine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D001706:Biopsy; D003937:Diagnosis, Differential; D004008:Diclofenac / Q000009:adverse effects* / Q000627:therapeutic use; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D005198:Fanconi Syndrome / Q000139:chemically induced* / Q000473:pathology; D005260:Female; D015483:HIV Antibodies / Q000276:immunology*; D006679:HIV Seropositivity / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000276:immunology*; D006801:Humans; D007687:Kidney Tubules, Proximal / Q000187:drug effects / Q000473:pathology; D008875:Middle Aged; D063065:Organophosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D000068698:Tenofovir
D019380:Anti-HIV Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D015483:HIV Antibodies; D063065:Organophosphonates; D004008:Diclofenac; D000068698:Tenofovir; D000225:Adenine