Persistent decline in estimated but not measured glomerular filtration rate on tenofovir may reflect tubular rather than glomerular toxicity
| Autor: | Evian Fernandez Garcia, Nico G G M Abeling, Frans J. Hoek, Kees Brinkman, Ray T Krediet, Ferdinand W. N. M. Wit, Christoph A Fux, Saskia M. E. Vrouenraets, Hansjakob Furrer, Peter Reiss |
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| Přispěvatelé: | Other departments, Amsterdam institute for Infection and Immunity, Global Health, Laboratory Genetic Metabolic Diseases, Nephrology, Amsterdam Public Health |
| Rok vydání: | 2011 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Tenofovir Anti-HIV Agents Kidney Glomerulus Immunology Organophosphonates Urology Renal function HIV Infections urologic and male genital diseases chemistry.chemical_compound Alpha-Globulins Proximal renal tubulopathy medicine Humans Immunology and Allergy Serum Albumin Randomized Controlled Trials as Topic Creatinine urogenital system business.industry Adenine virus diseases Middle Aged Renal Plasma Flow Effective Filtration fraction Kidney Tubules Treatment Outcome Infectious Diseases chemistry Renal blood flow Toxicity HIV-1 Female business Tubular secretion Glomerular Filtration Rate medicine.drug |
| Zdroj: | AIDS (London, England), 25(17), 2149-2155. Lippincott Williams and Wilkins |
| ISSN: | 0269-9370 |
| DOI: | 10.1097/qad.0b013e32834bba87 |
| Popis: | Tenofovir disoproxil fumarate (TDF) has been associated with proximal renal tubulopathy and reduction in estimated glomerular filtration rate (eGFR), without accounting for the tubular secretion of creatinine. A substudy was performed among 19 participants of a randomized 48-week trial, comparing continuing first-line zidovudine/lamivudine (ZDV/3TC) with switching to TDF/emtricitabine (FTC). GFR was measured with [(125)I]-iothalamate (mGFR) and effective renal plasma flow (ERPF) with [(131)I]-hippuran. eGFR and tubular effects were assessed using plasma and urine samples. Of the 19 patients, 18 were men, 15 whites, mean (SD) age 46.0 (8.9) years, plasma HIV-1 RNA less than 50 copies/ml in all. After 48 weeks, eGFR using Cockcroft-Gault equation and ERPF, but not mGFR, had significantly decreased, and urinary α1-microglobulin/creatinine and microalbumin/creatinine significantly increased in patients on TDF. Although phosphate metabolism on TDF was affected at week 4, differences between groups disappeared during follow-up. Replacing ZDV/3TC with TDF/FTC in this limited sample of virologically suppressed HIV-1-infected adults was associated with mild persistent tubular but not glomerular dysfunction over 48 weeks. The observed persistent decrease in Cockcroft-Gault-based eGFR, but not mGFR, rather than being indicative of glomerular dysfunction may be explained by TDF inhibiting tubular creatinine excretion |
| Databáze: | OpenAIRE |
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