Tenofovir Nephrotoxicity: 2011 Update

Author:

Fernandez-Fernandez Beatriz1,Montoya-Ferrer Ana2,Sanz Ana B.3,Sanchez-Niño Maria D.3,Izquierdo Maria C.1,Poveda Jonay1,Sainz-Prestel Valeria1,Ortiz-Martin Natalia1,Parra-Rodriguez Alejandro1,Selgas Rafael3,Ruiz-Ortega Marta1,Egido Jesus1,Ortiz Alberto14

Affiliation:

1. Nefrología, IIS-Fundacion Jimenez Diaz, Fundacion Renal Iñigo Alvarez de Toledo/Instituto Reina Sofia de Investigacion Nefrologica (FRIAT/IRSIN), Universidad Autonoma de Madrid, Madrid, Spain

2. Medicina Interna, IIS-Fundacion Jimenez Diaz, Madrid, Spain

3. Nefrología, IDiPaz, Universidad Autonoma de Madrid, Fundacion Renal Iñigo Alvarez de Toledo/Instituto Reina Sofia de Investigacion Nefrologica (FRIAT/IRSIN), Madrid, Spain

4. Unidad de Diálisis, Fundación Jiménez Díaz, Avenida Reyes Católicos 2, 28040 Madrid, Spain

Abstract

Tenofovir is an acyclic nucleotide analogue reverse-transcriptase inhibitor structurally similar to the nephrotoxic drugs adefovir and cidofovir. Tenofovir is widely used to treat HIV infection and approved for treatment of hepatitis B virus. Despite initial cell culture and clinical trials results supporting the renal safety of tenofovir, its clinical use is associated with a low, albeit significant, risk of kidney injury. Proximal tubular cell secretion of tenofovir explains the accumulation of the drug in these mitochondria-rich cells. Tenofovir nephrotoxicity is characterized by proximal tubular cell dysfunction that may be associated with acute kidney injury or chronic kidney disease. Withdrawal of the drug leads to improvement of analytical parameters that may be partial. Understanding the risk factors for nephrotoxicity and regular monitoring of proximal tubular dysfunction and serum creatinine in high-risk patients is required to minimize nephrotoxicity. Newer, structurally similar molecular derivatives that do not accumulate in proximal tubules are under study.

Publisher

Hindawi Limited

Subject

Infectious Diseases,Public Health, Environmental and Occupational Health,Dermatology,Immunology and Allergy

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