Drug-induced renal Fanconi syndrome

Area of Science:

• Nephrology
• Pharmacology
• Toxicology

Background:

• Therapeutic drugs can induce kidney proximal tubule (PT) toxicity, leading to renal Fanconi syndrome (FS).
• Commonly implicated drugs include cisplatin, ifosfamide, tenofovir, sodium valproate, aminoglycosides, and deferasirox.
• The true incidence of FS is likely underestimated due to diagnostic and reporting challenges.

Purpose of the Study:

• To review the causes, clinical features, complications, and monitoring of drug-induced Fanconi syndrome.
• To highlight the limitations of standard kidney function tests in detecting PT toxicity.
• To emphasize the importance of appropriate monitoring and timely intervention for drug-induced PT toxicity.

Main Methods:

• Literature review of drug-induced Fanconi syndrome.
• Analysis of clinical features and diagnostic markers.
• Evaluation of current monitoring strategies and management approaches.

Main Results:

• Fanconi syndrome presents with amino aciduria, low molecular weight proteinuria, hypophosphataemia, metabolic acidosis, and glycosuria.
• Serious complications include bone demineralization and progressive kidney function decline.
• Standard kidney function tests (eGFR, ACR) are insensitive to PT toxicity; specific monitoring is required.

Conclusions:

• Drug-induced PT toxicity is a significant clinical issue with potentially severe consequences.
• Early identification and management through appropriate monitoring are essential.
• Prompt drug withdrawal or dose reduction can lead to recovery, though chronic damage may persist.