Fanconi's Syndrome in HIV+ Adults: Report of Three Cases and Literature Review
- 1 May 2004
- journal article
- case report
- Published by Oxford University Press (OUP) in Journal of Bone and Mineral Research
- Vol. 19 (5) , 714-721
- https://doi.org/10.1359/jbmr.2004.19.5.714
Abstract
We diagnosed Fanconi's syndrome (phosphate depletion and dysfunction of the renal tubules) in three HIV+ patients. This was temporally related to their HIV treatment. Physicians caring for patients with HIV should recognize the association of this rare syndrome with antiretroviral medications and monitor their patients carefully. Introduction: Fanconi's syndrome is caused by increased excretion of phosphate, glucose, amino acids, and other intermediary metabolites, and can result in osteomalacia. Materials and Methods: We diagnosed this syndrome in three HIV+ patients. Results: The first was a 43-year-old woman referred for multiple painful stress fractures. She demonstrated hypophosphatemia, metabolic acidosis, phosphaturia, glucosuria, and generalized aminoaciduria. These abnormalities resolved with oral phosphate replacement and discontinuation of the antiretroviral medication tenofovir. The second patient was a 39-year-old man with hypophosphatemia and bone pain. His symptoms improved with discontinuation of adefovir and supplementation of phosphate, potassium, and calcitriol. The third patient was a 48-year-old man who presented with symptomatic tetany caused by hypocalcemia (total serum calcium of 6.5 mg/dl [8.5–10.5 mg/dl]). Nine months before presentation, he had been treated with cidofovir for retinitis caused by cytomegalovirus. With calcium, phosphate, potassium, and calcitriol therapy, his laboratory abnormalities improved substantially, although he continues to require daily electrolyte replacement. Conclusions: Each patient demonstrated generalized renal tubular dysfunction temporally related to treatment with antiretroviral drugs. The mechanism responsible for these abnormalities is not known; however, physicians caring for patients with HIV disease should recognize the association of Fanconi's syndrome with antiretroviral medications and monitor susceptible patients to prevent potential skeletal and neuromuscular complications.Keywords
This publication has 29 references indexed in Scilit:
- Fanconi-like syndrome and rhabdomyolysis in a person with HIV infection on highly active antiretroviral treatment including tenofovirJournal of Infection, 2003
- Renal lesions in HIV-1-positive patient treated with tenofovirAIDS, 2003
- Drug-induced Fanconi's syndromeAmerican Journal of Kidney Diseases, 2003
- Assessment of Mitochondrial Toxicity in Human Cells Treated with Tenofovir: Comparison with Other Nucleoside Reverse Transcriptase InhibitorsAntimicrobial Agents and Chemotherapy, 2002
- Toxicity of Antiretroviral Nucleoside and Nucleotide AnaloguesDrug Safety, 2000
- Fanconi's syndrome and tubulointerstitial nephritis in association with L-lysine ingestionAmerican Journal of Kidney Diseases, 1996
- Lactic acidosis and Fanconi's syndrome due to degraded tetracycline.BMJ, 1981
- Effect of treatment on renal function in severe osteomalacia due to Wilson's diseaseJournal of Clinical Pathology, 1970
- Acute reversible renal tubular dysfunction following intoxication with methyl-3-chromoneThe Journal of Pediatrics, 1968
- An experimental renal acidification defect in patients with hereditary fructose intoleranceJournal of Clinical Investigation, 1968