Division of Kidney Diseases and Hypertension, Department of Medicine, North Shore University Hospital and Long Island Jewish Medical Center, Hofstra North Shore-LIJ School of Medicine, Great Neck, NY, USA.
Ren Fail. 2013 Sep;35(8):1186-90. doi: 10.3109/0886022X.2013.817316. Epub 2013 Jul 25.
Antiretroviral medications, specifically tenofovir, have been linked to acute tubular necrosis in humans with a suggested mechanism of direct tubular injury. Rhabdomyolysis has rarely been described in patients on highly active antiretroviral therapy (HAART). To the best of our knowledge, severe recurrent rhabdomyolysis-induced acute kidney injury (AKI) in a HIV-infected patient on two different triple antiretroviral regimens has not been reported. We present a HIV-positive patient who first developed heme pigment-induced oliguric AKI due to non-traumatic rhabdomyolysis, 5 days after initiation of triple antiretroviral therapy. Renal function normalized 2 months after discontinuation of antiretroviral therapy. Two weeks after reinitiating a different HAART regimen, our patient developed a recurrent episode of severe rhabdomyolysis-induced AKI. Both rhabdomyolysis and AKI resolved after discontinuation of the second antiretroviral regimen. First tenofovir and subsequently abacavir seem to be the likely culprits in our case. We also briefly discuss tenofovir nephrotoxicity followed by a literature review on rhabdomyolysis in HIV-infected patients.
抗逆转录病毒药物，特别是替诺福韦，已被证明与人类急性肾小管坏死有关，其机制可能为直接肾小管损伤。在接受高效抗逆转录病毒治疗（HAART）的患者中，肌溶解症很少见。据我们所知，HIV 感染患者在两种不同的三联抗逆转录病毒方案中出现严重复发性肌溶解诱导的急性肾损伤（AKI）尚未见报道。我们报告了一例 HIV 阳性患者，在开始三联抗逆转录病毒治疗 5 天后，由于非创伤性肌溶解导致血红素色素诱导的少尿性 AKI。在停止抗逆转录病毒治疗后 2 个月，肾功能恢复正常。在重新开始另一种 HAART 方案 2 周后，我们的患者出现了复发性严重肌溶解诱导的 AKI。在停止第二种抗逆转录病毒方案后，肌溶解和 AKI 均得到缓解。在我们的病例中，似乎首先是替诺福韦，然后是阿巴卡韦是罪魁祸首。我们还简要讨论了替诺福韦的肾毒性，并对 HIV 感染患者的肌溶解症进行了文献复习。
