Conti Fabio, Vitale Giovanni, Cursaro Carmela, Bernardi Mauro, Andreone Pietro
Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy.
Ann Hepatol. 2016 Mar-Apr;15(2):273-6. doi: 10.5604/16652681.1193725.
Tenofovir disoproxil fumarate (TDF) is a nucleotide reverse transcriptase inhibitor indicated for treatment of patients with chronic hepatitis B virus (CHB) and human immunodeficiency virus (HIV) infections. Despite the good safety profile of the drug, Fanconi syndrome is a possible adverse reaction of TDF treatment, especially in HIV-infected patients. Only a few cases have been reported in patients with CHB-monoinfections. This report presents a case of a 58-year-old man with mild HBeAg-negative CHB who was exposed to TDF and developed drug-induced Fanconi syndrome. Renal dysfunction reverted after TDF discontinuation and a switch to entecavir, and viral replication remained suppressed. A literature review yielded six additional cases of TDF-induced Fanconi syndrome, all with risk factors for renal dysfunction despite the patients having normal glomerular filtration rates. We discuss the overall risk for Fanconi syndrome in CHB-monoinfected patients exposed to TDF and the importance of careful monitoring of glomerular and tubular functions even when pre-existing kidney disease is not present.
富马酸替诺福韦二吡呋酯（TDF）是一种核苷酸逆转录酶抑制剂，用于治疗慢性乙型肝炎病毒（CHB）感染和人类免疫缺陷病毒（HIV）感染患者。尽管该药物安全性良好，但范科尼综合征是TDF治疗可能出现的不良反应，尤其在HIV感染患者中。CHB单一感染患者中仅有少数病例报道。本报告介绍了一例58岁轻度HBeAg阴性CHB男性患者，其接触TDF后发生药物性范科尼综合征。停用TDF并换用恩替卡韦后肾功能恢复正常，病毒复制仍受抑制。文献回顾又发现6例TDF诱导的范科尼综合征病例，尽管患者肾小球滤过率正常，但均有肾功能不全的危险因素。我们讨论了CHB单一感染患者接触TDF后发生范科尼综合征的总体风险，以及即使不存在既往肾脏疾病时仔细监测肾小球和肾小管功能的重要性。
