Analysis of cases with Fanconi syndrome due to tenofovir
10.3760/cma.j.issn.1008-5734.2017.04.005
- VernacularTitle:替诺福韦致范可尼综合征文献病例分析
- Author:
Wenxi WANG
1
;
Guohong PAN
;
Sanlan WU
Author Information
1. 431600,湖北省汉川市人民医院药剂科
- Publication Type:Journal Article
- Keywords:
Tenofovir;
Fanconi syndrome
- From:
Adverse Drug Reactions Journal
2017;19(4):267-271
- CountryChina
- Language:Chinese
-
Abstract:
Objective To understand the clinical characteristics, treatment and prognosis of tenofovir (TDF)-induced Fanconi syndrome (FS).Methods The related databases were electronically searched for the cases of FS induced by TDF before November 2016.The related data of the patients were recorded and summarized.The results of detection of related laboratory parameters before and after the treatment for FS induced by TDF were compared.The clinical characteristics, and prognosis of FS induced by TDF were analyzed.The correlation of TDF and FS was analyzed by using Naranjo probability scale.Results A total of 59 cases were collected comprising 42 males (71.2%) and 17 females (28.8%) with age from 17 to 82 years, and the average age (46±13) years.The number of cases with human immunodeficiency virus (HIV) infection, hepatitis B virus (HBV) infection, and HIV with HBV infection were 48 (81.4%), 8 (13.6%), and 3 (5.1%), respectively.Eight patients (13.6%) were treated with TDF only, 51 patients (86.4%) were treated with TDF combined with other antiviral drugs.The top 3 of combined drugs were lopinavir/ritonavir (26 cases) , lamivudine (21 cases), and abacavir (14 cases).The dose of TDF was 300 mg/d in 24 patients with HIV infection, and 245 mg/d in 3 patients with HBV infection.The other patients′ dose of TDF was not reported.The time from medication of TDF to FS occurrence was 1 to 60 months in the patients with HIV infection, 3 to 45 months in the patients with HBV infection.The main clinical manifestations were diuresis (16 cases), polydipsia (10 cases), loss of weight (10 cases), fatigue (9 cases), and lower limb joint pain (8 cases), etc.The abnormities of laboratory parameters included increased serum creatinine concentration (51 cases), positive urine glucose (50 cases), positive urine protein (49 cases), decreased blood phosphate (46 cases), hypokalemia (23 cases), decreased blood bicarbonate (21 cases), increased blood urea nitrogen (12 cases), hypocalcemia (9 cases), and hyponatremia (9 cases), etc.The number of cases with acute renal failure, nephrogenic diabetes insipidus, osteoporosis, halisteresis, hypokalemic periodic paralysis, and stress fracture were 12, 7, 4, 3, 3, and 2, respectively.TDF was withdrawn in all patients after the occurrence of FS.The patients received the symptomatic treatments including intravenous hydration, supplement of potassium, phosphorus and calcium.Forty-five patients changed to use other antiviral drugs.Symptoms in 45 patients with FS were improved within 3 days to 5 months, and the laboratory indicators returned to normal within 2 weeks to 24 months.Thirteen patients′ serum creatinine concentration was still at high levels after drug withdrawal, prescription change, and 1 to 24 months of symptomatic treatments.A patient died from severe sepsis 2 months after drug withdrawal.The results of association analysis showed that FS in 11 patients (18.6%) were probably related to TDF and in 48 patients (81.4%) were possibly related to TDF.ConclusionsThe clinical manifestations of FS due to TDF are similar to primary FS.Most of the patients can return to normal after drug withdrawal and symptomatic treatment, some patients suffer irreversible renal damage.
