title: Acquired Fanconi syndrome associated with prolonged adefovir dipivoxil therapy in a chronic hepatitis B patient.
abstract: Adefovir dipivoxil (ADV) is one of the commonly used antiviral agents in the treatment of chronic hepatitis B infection. Nephrotoxicity is dose related and occurred at a daily dosage of >30 mg. However, it is now increasingly recognized that nephrotoxicity can occur at a daily dose of 10 mg. We present a case of acquired Fanconi syndrome in a patient with chronic hepatitis B who had been treated with ADV for 4 years. She presented with progressive muscle weakness and generalized bone pain. The laboratory results showed the feature of proximal renal tubule dysfunction, particularly severe hypophosphatemia. Diagnostic approach to hypophosphatemia and proximal renal tubular dysfunction is discussed. After switching over from ADV to entecavir, her symptoms and laboratory findings returned to normal. Acquired Fanconi syndrome can be associated with ADV at a conventional dosage, and therefore, patients treated with long-term ADV should have regular monitoring of renal function and calcium and phosphate levels.
authors.affiliation: 1Division of Gastroenterology and Hepatology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong; and 2Division of Endocrinology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong.
authors.forename: Siu-Tong
authors.initials: ST
authors.lastname: Law
authors.forename: Kin Kong
authors.initials: KK
authors.lastname: Li
authors.forename: Yiu Yan
authors.initials: YY
authors.lastname: Ho
mesh_terms: D000225:Adenine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D002118:Calcium / Q000378:metabolism; D016903:Drug Monitoring / Q000379:methods; D005198:Fanconi Syndrome / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D019694:Hepatitis B, Chronic / Q000188:drug therapy*; D006801:Humans; D017674:Hypophosphatemia / Q000139:chemically induced; D063065:Organophosphonates / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D000998:Antiviral Agents; D063065:Organophosphonates; D000225:Adenine; D002118:Calcium; C106812:adefovir dipivoxil