title: Adefovir nephrotoxicity in a renal allograft recipient.
abstract: Adefovir dipivoxil, an oral prodrug of adefovir, is used in the treatment of lamivudine-resistant hepatitis B virus (HBV) infection. Nephrotoxicity manifesting as proximal renal tubular dysfunction and acute tubular necrosis (ATN) were commonly reported in the past, when higher doses were used for the treatment of human immunodeficiency virus infection. However, nephrotoxicity is rare at lower doses that are currently recommended for the treatment of HBV infection. A 31-year-old female was detected to be hepatitis B surface antigen positive months after a kidney transplant. The patient was initiated on lamivudine, but developed resistance after 1 year of treatment, at which time low-dose adefovir was added. The patient developed renal allograft dysfunction after 10 months of starting adefovir. Serum creatinine increased from 1.1 mg/dl to 1.9 mg/dl, along with progressively increasing sub-nephrotic proteinuria. Renal allograft biopsy revealed features of ATN. After discontinuation of adefovir, proteinuria resolved and renal dysfunction improved slowly over the next 2 years. Adefovir-induced nephrotoxicity, although uncommon at lower doses, needs to be considered in the differential diagnosis of renal dysfunction and sub-nephrotic proteinuria occurring in patients receiving adefovir for prolonged periods.
authors.affiliation: Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: N
authors.initials: N
authors.lastname: George
authors.affiliation: Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: G
authors.initials: G
authors.lastname: Basu
authors.affiliation: Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: A
authors.initials: A
authors.lastname: Mohapatra
authors.affiliation: Department of Hepatology, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: U
authors.initials: U
authors.lastname: Zachariah
authors.affiliation: Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: P
authors.initials: P
authors.lastname: Abraham
authors.affiliation: Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: A
authors.initials: A
authors.lastname: Korula
authors.affiliation: Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: S
authors.initials: S
authors.lastname: Varughese
authors.affiliation: Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: C K
authors.initials: CK
authors.lastname: Jacob
authors.affiliation: Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: V
authors.initials: V
authors.lastname: Tamilarasi
keywords: Adefovir; hepatitis B; lamivudine-resistant; nephrotoxicity; renal; transplant.