Yoshimoto Eiichiro, Konishi Mitsuru, Uno Kenji, Nakagawa Chiyo, Yonekawa Shinsuke, Kasahara Kei, Maeda Koichi, Mikasa Keiichi
Center for Infectious Diseases, Nara Medical University.
Kansenshogaku Zasshi. 2008 Nov;82(6):650-3. doi: 10.11150/kansenshogakuzasshi1970.82.650.
A 58-year-old man admitted for fever, nausea, vomiting, and anuria after the start of HAART, including tenofovir, had a viral load of 1.1 x 10(5) copies/mL, a CD4-positive lymphocyte count of 81/microL, and serum creatinine of 0.8 mg/dL before HAART. He underwent renal biopsy and temporary dialysis. We concluded that the patient had acute tubular necrosis because of potentially impaired renal function and the high amount of medication, and judging from the renal biopsy specimen and clinical course. When implementing HAART, physicians should be aware of and monitor potential patient misunderstanding of instructions on dosage and administration and for possible complications in medicinal combinations and potential side effects. TDF taken together with lopinavir may increase the plasma concentration of TDF or other medications that could worsen renal function. It should also be noted that renal dysfunction is a potential complication in the elderly.
一名58岁男性在开始接受包括替诺福韦在内的高效抗逆转录病毒治疗（HAART）后出现发热、恶心、呕吐和无尿症状，HAART治疗前其病毒载量为1.1×10⁵拷贝/毫升，CD4阳性淋巴细胞计数为81/微升，血清肌酐为0.8毫克/分升。他接受了肾活检和临时透析。我们得出结论，由于潜在的肾功能损害和大量用药，并根据肾活检标本和临床病程判断，该患者患有急性肾小管坏死。在实施HAART时，医生应意识到并监测患者对剂量和用药说明可能存在的误解，以及药物组合可能出现的并发症和潜在副作用。替诺福韦与洛匹那韦合用可能会增加替诺福韦或其他药物的血浆浓度，从而加重肾功能损害。还应注意的是，肾功能障碍是老年人的潜在并发症。
