title: Distal renal tubular acidosis without renal impairment after use of tenofovir: a case report.
abstract: Tenofovir, one of antiretroviral medication to treat human immunodeficiency virus (HIV) infection, is known to cause proximal renal tubular acidosis such as Fanconi syndrome, but cases of distal renal tubular acidosis had never been reported.
  
  
  
  A 20-year-old man with HIV infection developed nausea and vomiting without diarrhea after starting antiretroviral therapy. Arterial blood gas revealed non-anion-gap metabolic acidosis and urine test showed positive urine anion gap. Tenofovir, one of antiretroviral medicine the patient received, was considered to be the cause of this acidosis and all antiretroviral drugs were discontinued. Symptoms disappeared promptly without recurrence of symptoms after resuming antiretroviral medications without tenofovir.
  
  
  
  Distal renal tubular acidosis caused by tenofovir, without renal impairment is very rare. Since causes of nausea and vomiting among HIV/AIDS patients are very diverse, awareness of this phenomenon is useful in diagnosing and managing the problem.
authors.affiliation: Division of Infectious Diseases Therapeutics, Kobe University Graduate School of Medicine, Kusunokicho 7-5-2, Chuoku, Kobe, Hyogo, Japan, 650-0017. kentaroiwata1969@gmail.com.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Iwata
authors.affiliation: Division of Infectious Diseases Therapeutics, Kobe University Graduate School of Medicine, Kusunokicho 7-5-2, Chuoku, Kobe, Hyogo, Japan, 650-0017.
authors.forename: Manabu
authors.initials: M
authors.lastname: Nagata
authors.affiliation: Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kusunokicho 7-5-2, Chuoku, Kobe, Hyogo, Japan, 650-0017.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Watanabe
authors.affiliation: Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kusunokicho 7-5-2, Chuoku, Kobe, Hyogo, Japan, 650-0017.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Nishi
mesh_terms: D000141:Acidosis, Renal Tubular / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis*; D019380:Anti-HIV Agents / Q000009:adverse effects*; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy; D006801:Humans; D008297:Male; D000068698:Tenofovir / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D000068698:Tenofovir
keywords: Case report; HIV; Renal tubular acidosis; Tenofovir