Two Cases of Hypophosphatemic Osteomalacia After Long-term Low Dose Adefovir Therapy in Chronic Hepatitis B and Literature Review.
Adefovir dipivoxil (ADV) is a nucleotide used as long-term therapy of chronic hepatitis B. Many published reports have shown that long-term high-dose therapy with adefovir can be associated with proximal renal tubular dysfunction resulting in significant hypophosphatemia, renal insufficiency and osteomalacia. We have encountered two patients who developed evidence of hypophosphatemic osteomalacia while on long-term low-dose adefovir therapy for chronic hepatitis B. We report on its clinical features and its potential resolution with cessation of the drug and supplementation with phosphate. We also reviewed the other published cases associated with hypophosphatemic osteomalacia after low-dose adefovir therapy. The symptoms and the hypophosphatemia improved after cessation of the drug and supplementation with phosphate in most cases. Patients taking adefovir long-term should receive regular investigation of the phosphate level and renal function.
Department of Intermal Medicine, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea.
Hye Jin
HJ
Jeong
Department of Intermal Medicine, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea.
Ji Min
JM
Lee
Department of Intermal Medicine, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea.
Tae Han
TH
Lee
Department of Intermal Medicine, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea.
Ji Yeon
JY
Lee
Department of Intermal Medicine, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea.
Han Byeol
HB
Kim
Department of Intermal Medicine, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea.
Mi Hwa
MH
Heo
Department of Intermal Medicine, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea.
Go
G
Choi
Department of Intermal Medicine, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea.
Jin Nyeong
JN
Chae
Department of Intermal Medicine, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea.
Ji-Min
JM
Kim
Department of Intermal Medicine, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea.
Sang-Hyon
SH
Kim
Department of Pathology, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea.
Kun Young
KY
Kwon
Adefovir dipivoxil; Hypophosphatemia; Kidney diseases; Osteomalacia