Annie Talbot
Publication Details
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Acute renal failure in 4 HIV-Infected patients: potential association with Tenofovir and ARVs
Canadian Journal of Infectious Disease and Medical Microbiology. 2008; (1): 75-76
Backgrounds:. Tenofovir has been associated with different forms of renal impairment including Fanconi syndrome. However, we observed non-Fanconi renal failure, in patients with other factors for nephrotoxicity, in which tenofovir might be a contributing factor. Methods: We studied retrospectively all files of HIV positive patients treated with tenofovir who developed acute renal failure at Hôpital Saint-Luc du CHUM, from January 1st 2004 to December 31st 2005. Results: Each of the four cases had more than one risk factor for nephrotoxicity. Three of them were also taking non-steroidal anti-inflamatory drugs (NSAID). The first patient had acute tubular necrosis (ATN) associated to naproxen. He also had severe liver cirrhosis. The renal status was considered irreversible and the patient deceased. The second patient developed rhabdomyolysis secondary to cocaine use: HAART was continued, naproxen was stopped and renal function improved with hydration. The third patient developed ATN associated to indomethacin: HAART was stopped and dialysis was performed and is still necessary. The last patient was diabetic, took tenofovir for more then 6 months and developed renal failure following dehydration from nausea and vomiting. HAART was stopped and renal function improved following rehydration. Conclusion: Four patients treated with tenofovir developed acute renal failure without Fanconi syndrome. The cumulative use of diuretics, didanosine, NSAID and tenofovir and other underlying diseases altering kidney function such as diabetes or liver cirrhosis may have played a role in these cases. The combination of tenofovir and NSAID should be used with caution in patients having other risk factors of nephrotoxicy. Key words: tenofovir, NSAID, renal failure, naproxen, indomethacin, acute tubular necrosis
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