Tenofovir-induced kidney disease: an acquired renal tubular mitochondriopathy

Tenofovir, used in combination with other antiretroviral agents, is an effective therapy for HIV infection. Although large clinical studies and post-marketing data support a benign renal profile for tenofovir, numerous cases of kidney injury raise concern for nephrotoxic potential. Early human studies and experimental evidence suggested that tenofovir itself was not associated with mitochondrial toxicity within the kidney. However, recent animal data demonstrate that tenofovir causes mitochondrial DNA depletion and mitochondrial toxicity. Herlitz et al. confirm the nephrotoxicity of tenofovir in humans. They describe its clinical consequences, histopathologic findings, and its mitochondrial toxicity in HIV+ patients.