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Tenofovir disoproxil fumarate induced severe kidney injury. Case report

https://doi.org/10.28996/2618-9801-2021-1suppl-99-105

Abstract

The article describes a clinical case of severe kidney injury in a 66-year-old HIV-infected man who received Tenofovir disoproxil fumarate (TDF), lamivudine and etravirine. The man was infected with HIV in 2008 during heterosexual transmission, received antiretroviral therapy (ART) with a change of medications due to adverse events (efavirenz-neurotoxicity, zidovudine - anemia, abacavir - dyslipidemia, atazanavir - cholestasis, microlithiasis): zidovudine + lamivudine + efavirenz + ritonavir → zidovudine + lamivudine + atazanavir + ritonavir → abacavir + lamivudine + atazanavir + ritonavir. In 2017, the following treatment regimens were prescribed: TDF, lamivudine, etravirine. Renal function at the time of therapy initiation was normal. In October 2019 the GFR (CKD-EPI) decreased to 58 ml/min/1.73 m2 (serum creatinine concentration 113 mmol/l), proteinuria, glucosuria appeared. The patient was referred to nephrologist, the ART was not changed. The patient did not visit a nephrologist. In February 2020, the patient was admitted to the nephrology department because of oliguria (diuresis 600 ml/24-h), severe renal injury - serum creatinine was 640 mmol/l (GFR 7 ml/min/1.73 m2), urea 29 mmol/L, dyselectrolytemia, daily protein excretion 0.6 g. A kidney biopsy was performed, which showed massive inflammation, total acute tubular necrosis, focal karyomegaly, multifocal formation of megamitochondria, numerous massive protein cylinders, single myoglobin cylinders (rhabdomyolysis); the development of complete sclerosis of 14% of the glomeruli. The presence and severity of tubulo-interstitial fibrosis were not evaluated due to the severity of inflammation. Diagnosis: chronic tubulointerstitial nephritis of iatrogenic (drug) origin with acute kidney injury. Infusion therapy and changeover of antiretroviral therapy (ART) for a solution of lamivudine 100 mg per day and lopinavir/ritonavir 800/200 mg per day led to a gradual partial improvement in nephrological parameters: renal function, electrolyte metabolism (in November 2020 - GFR 37 ml/min/1.73 m2), spot urine sample also improved.

About the Authors

I. N. Konakova
City Mariinsky hospital
Russian Federation


N. V. Dunaeva
Centers for AIDS and Other Infectious Diseases
Russian Federation


O. A. Vorobyeva
“National Center of Clinical Morphological Diagnostics”
Russian Federation


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Review

For citations:


Konakova I.N., Dunaeva N.V., Vorobyeva O.A. Tenofovir disoproxil fumarate induced severe kidney injury. Case report. Nephrology and Dialysis. 2021;23(1):99-105. (In Russ.) https://doi.org/10.28996/2618-9801-2021-1suppl-99-105

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ISSN 2618-9801 (Online)