Nephrotoxicity Fanconi Syndrome

Nephrotoxicity IDV potentially TDF Onset IDV—months after therapy TDF—weeks to months after therapy Symptoms IDV—asymptomatic rarely develop end-stage renal disease TDF—asymptomatic to symptoms of nephrogenic diabetes insipidus, Fanconi syndrome 1. History of renal disease 2. Concomitant use of nephrotoxic drugs Avoid use of other nephrotoxic drugs adequate hydration if on IDV monitor creatinine, urinalysis, serum potassium and phosphorus in patients at risk D/C offending agent, generally reversible supportive care electrolyte replacement as indicated... 

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... 

In a few cases, gentamicin nephrotoxicity was associated with a Fanconi syndrome, with raised serum enzymes activities in the urine. Among these, murami-dase seemed to be especially useful in checking for proximal tubular dysfunction (30). 

Experience with ifosfamide-contain-ing regimens has revealed a consistent clinical pattern of nephrotoxicity. Fanco-ni syndrome, which is characterized by acid, sodium, potassium, magnesium, and small molecular weight proteins, occurs in 1-5% of the children who have received repeated treatments of ifosfamide [94] [95]. In fact the development of rickets secondary to Fanconi syndrome has been reported following treatment with ifosfamide [96]. Patients who have received therapy with cisplatin or carboplatin in addition to ifosfamide may be at greater risk for development of Fanconi syndrome [97]. Hemorrhagic cystitis is a significant toxicity that occurs with ifosfamide administration [98,... 

This chapter describes the acute and chronic nephrotoxic effects of lead in human populations. These effects have long been recognized in chronic adult occupational lead exposures and in nonoccupational adult exposures arising from dietary Pb intakes, producing disorders such as gouty nephropathy. In acute childhood Pb exposure, severe kidney effects in the form of Fanconi syndrome were identified in the early pediatric literature. The syndrome often co-occurred with acute encephalopathy. 

Outdated products Under no circumstances should outdated tetracyclines be administered the degradation products of tetracyclines are highly nephrotoxic and have, on occasion, produced a Fanconi-like syndrome. 

Nausea and vomiting confusion nephrotoxicity metabolic acidosis and renal Fanconi s syndrome cardiac toxicity with high doses... 

Nephrotoxicity is the principal dose-limiting side effect of intravenous cidofovir. Proximal tubular dysfunction includes proteinuria, azotemia, glycosuria, metabolic acidosis and, uncommonly, Fanconi s syndrome. Concomitant oral probenecid and saline prehydration reduce the risk of renal toxicity. 

Rena] toxicity One form of renal tubular acidosis, Fanconi s syndrome, has been attributed to use of outdated tetracyclines. Though not directly nephrotoxic, tetracyclines may exacerbate preexisting renal dysfunction. 

Tetracyclines 5-12 h > 1 g/d in infants Benign intracranial hypertension. Degradation products (eg, expired prescription) are nephrotoxic, may cause Fanconi-like syndrome. Some products contain sulfites. 

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