title: [Tenofovir nephrotoxicity].
abstract: Tenofovir is currently the only commercially available nucleotidic reverse-transcriptase inhibitor of human immunodeficiency virus (HIV). It is overall very well tolerated and is prescribed to millions of patients-without any specific monitoring in developing countries. However a significant nephrotoxicity has been described. Acute nephrotoxicity is well characterized. Tenofovir is excreted in urine by proximal tubular epithelial cells. In case of cytoplasmic accumulation, tenofovir inhibits mitochondrial DNA polymerase γ, which causes a dysfunction of the respiratory chain, and in turn an alteration of the energy-deprived cells. Fanconi syndrome is the clinical expression of tenofovir acute toxicity, with sometimes an associated acute kidney failure. These abnormalities are usually reversible, at least partially, when tenofovir is discontinued. Tenofovir chronic toxicity has been debated but seems now well established by several cohort studies, even though it pathophysiology has yet to be understood. It manifests as an accelerated glomerular filtration rate decline in treated patients with no other renal abnormalities. The identification of this chronic toxicity was probably blurred by multiple cofactors, usually excluded from clinical trials. Simple measures such as dose adaptation to kidney function, identification of risk factors, and plasmatic tenofovir concentration monitoring can help decrease the risk of nephrotoxicity.
authors.affiliation: Service d'urologie néphrologie transplantation, groupe hospitalier universitaire Pitié-Salpêtrière-Charles-Foix, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Isnard-Bagnis
authors.affiliation: Service d'urologie néphrologie transplantation, groupe hospitalier universitaire Pitié-Salpêtrière-Charles-Foix, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Service information conseil adaptation rénale (Icar), groupe hospitalier universitaire Pitié-Salpêtrière-Charles-Foix, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
authors.forename: Blandine
authors.initials: B
authors.lastname: Aloy
authors.affiliation: Service d'urologie néphrologie transplantation, groupe hospitalier universitaire Pitié-Salpêtrière-Charles-Foix, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France; Service information conseil adaptation rénale (Icar), groupe hospitalier universitaire Pitié-Salpêtrière-Charles-Foix, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Deray
authors.affiliation: Service d'urologie néphrologie transplantation, groupe hospitalier universitaire Pitié-Salpêtrière-Charles-Foix, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France. Electronic address: jerome.tourret@aphp.fr.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Tourret
mesh_terms: D000208:Acute Disease; D002908:Chronic Disease; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects*; D012307:Risk Factors; D000068698:Tenofovir / Q000009:adverse effects*
chemical_list: D018894:Reverse Transcriptase Inhibitors; D000068698:Tenofovir
keywords: Acute kidney injury; Antiretroviral; Antirétroviral; Chronic kidney disease; Drug nephrotoxicity; Drug side effect; Effets secondaires médicamenteux; Fanconi syndrome; Insuffisance rénale aiguë; Insuffisance rénale chronique; Syndrome de Fanconi; Toxicité rénale; Tubulopathie; Tubulopathy