Tenofovir-associated renal and bone toxicity

Area of Science:

• Nephrology
• Infectious Diseases
• Bone Metabolism

Background:

• Tenofovir (TDF) is a widely used antiretroviral medication for HIV treatment.
• Potential renal and bone toxicities associated with TDF therapy require careful monitoring.
• Understanding the clinical presentation and pathogenic mechanisms of TDF toxicity is crucial for patient management.

Purpose of the Study:

• To describe the clinical presentation of renal and bone abnormalities in HIV patients treated with TDF.
• To identify appropriate screening methods for TDF-associated toxicity.
• To elucidate the pathogenic mechanism of TDF-induced renal impairment.

Main Methods:

• Retrospective case series of HIV-infected patients referred to a specialist HIV renal clinic.
• Inclusion criteria: TDF as the primary cause of renal impairment, with available pre- and post-treatment data.
• Data collection via case note review and clinic databases.

Main Results:

• Twenty-two patients (1.6%) developed TDF-associated renal toxicity, all with normal baseline creatinine.
• Common presentations included proteinuria, Fanconi syndrome (8 patients), and bone pain with osteomalacia (12 patients).
• Proximal tubular dysfunction, evidenced by tubular proteinuria, reduced phosphate transport, and glycosuria, was identified as the likely pathogenic mechanism.

Conclusions:

• Renal toxicity is a significant concern in patients receiving TDF.
• Clinical manifestations include renal dysfunction, Fanconi syndrome, and osteomalacia.
• Proximal tubular toxicity is a common mechanism underlying TDF-associated adverse effects.