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Kidney tubular abnormalities in the absence of impaired glomerular function in HIV patients treated with tenofovir

Labarga, Pabloa; Barreiro, Pabloa; Martin-Carbonero, Luza; Rodriguez-Novoa, Soniab; Solera, Carmena; Medrano, Josea; Rivas, Pabloa; Albalater, Martac; Blanco, Franciscoa; Moreno, Victoriaa; Vispo, Eugeniaa; Soriano, Vincenta

doi: 10.1097/QAD.0b013e3283262a64
Clinical Science

Background: Tenofovir (TDF) is the most widely prescribed antiretroviral drug. Kidney abnormalities are the main concern using the drug. As glomerular function is infrequently affected in patients treated with TDF, herein, we report the results of an extensive examination of tubular function.

Methods: Cross-sectional study of plasma and 24 h urine markers of kidney tubulopathy (glucosuria, hyperaminoaciduria, hyperphosphaturia, hyperuricosuria and β2-microglobulinuria) could be allocated in three groups: patients under a TDF-containing HAART; patients on HAART never exposed to TDF; and antiretroviral-naive individuals. Significant tubular damage was defined when at least two of these parameters were repeatedly present, being at least one part of the Fanconi syndrome criteria (glucosuria, hyperaminoaciduria and hyperphosphaturia). Glomerular function was assessed using creatinine clearance.

Results: A total of 284 consecutive HIV patients were examined, 154 on TDF, 49 on other HAART regimens and 81 drug-naive. No significant differences in creatinine clearance were observed when comparing distinct groups. The proportion of patients with tubular damage in groups 1, 2 and 3 were 22, 6 and 12%, respectively. In a multivariate analysis [odds ratio (OR) {95% confidence interval (CI)} P], the only independent predictors of tubular dysfunction were TDF use (21.6, 4.1–113, <0.001) and older age (1.1 per year, 1.0–1.1, 0.01).

Conclusion: Exposure to TDF is associated with an increased risk over time of kidney tubular abnormalities in the absence of significant impaired glomerular function. Although long-term consequences of this tubulopathy are unknown, close monitoring of accelerated bone mineral loss and renal insufficiency are warranted. Periodic screening of tubular function parameters should be recommended to patients receiving TDF.

aInfectious Diseases Department, Spain

bPharmacology Unit, Hospital Carlos III, Madrid, Spain

cNephrology Department, Fundación Jimenez Diaz, Madrid, Spain.

Received 12 September, 2008

Revised 15 November, 2008

Accepted 11 December, 2008

Correspondence to Dr Vincent Soriano, Department of Infectious Diseases, Hospital Carlos III, Calle Sinesio Delgado 10, Madrid 28029, Spain. Tel: +34 91 4532500; fax: + 34 91 7336614; e-mail: vsoriano@dragonet.es

© 2009 Lippincott Williams & Wilkins, Inc.