Tenofovir Fanconi syndrome

Renal function impairment Renal impairment, including cases of acute renal failure and Fanconi syndrome, has been reported in association with the use of tenofovir. Avoid tenofovir with concurrent or recent use of a nephrotoxic agent. Carefully monitor patients at risk for, or with a history of, renal dysfunction and patients... 

Adverse effects are not a major concern with the use of tenofovir. The occurrence of acute renal failure and Fanconi syndrome is rare. Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have also been observed. 

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Malik, A, Abraham P, Malik N. Acute renal failure and Fanconi syndrome In an AIDS patient on tenofovir treatment - case report and review of the literature. J Infection 2005 51 e61-65. 

Rollot F, Nazal EM, Chauvelot-Moachon L et al. Tenofovir-related fanconi syndrome with nephrogenic diabetes insipidus in a patient with acquired immunodeficiency syndrome the role of lopinavir-rltonavir-didanosine. Clin Infect Dis 2003 37 e174-6. 

Vilchez-Aparicio V, Mir M, Rodriguez B, Sanz J. Sindrome de fanconi asociado a tratamiento con tenofovir a proposito de dos casos. [Fanconi syndrome associated with tenofovir treatment a presentation of two cases.] Enferm Infecc Microbiol Clin 2010 28(9) 653. ... 

Izzedine H, Thibault V, Valantin MA, Peytavin G, Schneider L, Benhamou Y. Tenofovir/probenecid combination in HIV/HBV-coinfected patients how to escape Fanconi syndrome recurrence AIDS 2010 24(7) 1078-9. 

Irizarry-Alvarado JM, Dwyer JP, Brumble LM, Alvarez S, Mendez JC. Proximal tubular dysfunction associated with tenofovir and didanosine causing Fanconi syndrome and diabetes insipidus a report of 3 cases. AIDS Read 2009 19 (3) 114-21. 

Dm Gracey, Fernando M, Ziegler J, White CP, Post JJ. An unrecognized case of tenofovir-associated Fanconi syndrome. Med J Aust... 

Kiyasu Y, Koganemaru H, Hitomi S. Fanconi syndrome-like tubular acidosis associated with a tenofovir-containing antiretroviral regimen in a human immunodeficiency virus-1 infected Asian woman. J Infect Chemother 2012 18(2) 255-7. 

Gastrointestinal complaints (eg, nausea, diarrhea, vomiting, flatulence) are the most common adverse effects but rarely require discontinuation of therapy. Other potential adverse effects include headache and asthenia. Tenofbvir-associated proximal renal tubulopathy causes excessive renal phosphate and calcium losses and 1-hydroxylation defects of vitamin D, and preclinical studies in several animal species have demonstrated bone toxicity (eg, osteomalacia). Monitoring of bone mineral density should be considered with long-term use in those with risk factors for or with known osteoporosis, as well as in children. Reduction of renal function over time, as well as cases of acute renal failure and Fanconi s syndrome, have been reported in patients receiving tenofovir alone or in combination with emtricitabine. For this reason, tenofovir should be used with caution in patients at risk for renal dysfunction. Tenofovir may compete with other drugs that are actively secreted by the kidneys, such as cidofovir, acyclovir, and ganciclovir. 

Tenofovir generally is well tolerated, with few adverse events except for flatulence. Rare episodes of acute renal failure and Fanconi s syndrome have been reported, and the drug should be used with caution in patients with preexisting renal disease. It can increase the AUC of didanosine, and the drugs probably should not be used together. 

Electrolyte balance Hypokalemia has been reported in a patient with normal renal function taking tenofovir [76 ], and Fanconi s syndrome can occur [77, 78, 79" ] and can be associated with loss of bone mineral density [80 ]. 

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