Renal tubular dysfunction during long-term adefovir or tenofovir therapy in chronic hepatitis B.
Renal tubular dysfunction during long-term adefovir or tenofovir therapy in chronic hepatitis B.
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慢性乙型肝炎的长期adefovir或Tenofovir疗法期间的肾小管功能障碍。
DOI：
10.1111/j.1365-2036.2012.05093.x
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发表时间：
2012-06
影响因子：
7.6
通讯作者：
Hoofnagle JH
中科院分区：
文献类型：
--
作者：
Gara N;Zhao X;Collins MT;Chong WH;Kleiner DE;Jake Liang T;Ghany MG;Hoofnagle JH
阿德福韦和替诺福韦是核苷酸类似物，用于慢性B型肝炎的长期治疗。副作用很少，但长期和高剂量治疗与近端肾小管功能障碍（RTD）有关。评估慢性B型肝炎长期核苷酸治疗期间RTD的发生率。共有51名患者正在接受治疗的临床中心，美国国立卫生研究院进行了研究。RTD的诊断需要重新出现五个特征中的至少三个：低磷酸盐血症、低尿酸血症、血清肌酐升高、蛋白尿或糖尿。在接受阿德福韦酯（n = 42）、替诺福韦酯（n = 4）或阿德福韦酯后替诺福韦酯（n = 5）治疗1-10（平均7.4）年的51例患者中，7例（14%）发生RTD。至发作时间范围为22至94（平均49）个月，估计10年累积发生率为15%。所有7例患者的尿磷酸盐最大肾小管重吸收百分比均较低（<82%）。RTD患者年龄较大（58 vs. 44岁; P = 0.01），基线肾小球滤过率较低（82 vs. 97 cc/min; P = 0.08）;但在其他特征方面无差异。6例RTD患者改用恩替卡韦治疗，所有患者随后血清磷酸盐（2.0-3.0 mg/dL）、肌酐（1.6-1.1 mg/dL）、尿酸（2.7 - 3.8 mg/dL）和蛋白尿均有所改善。在接受阿德福韦酯或替诺福韦酯治疗2-9年的患者中，15%的患者会发生肾小管功能障碍，并且在更换其他抗病毒药物后部分可逆。在长期阿德福韦酯和替诺福韦酯治疗期间，应谨慎监测血清磷酸盐、肌酐和尿液分析。
Adefovir and tenofovir are nucleotide analogues used as long-term therapy of chronic hepatitis B. Side effects are few, but prolonged and high-dose therapy has been associated with proximal renal tubular dysfunction (RTD). To assess the incidence of RTD during long-term nucleotide therapy of chronic hepatitis B. A total of 51 patients being treated at the Clinical Center, National Institutes of Health were studied. Diagnosis of RTD required de novo appearance of at least three of five features: hypophosphataemia, hypouricaemia, serum creatinine elevation, proteinuria or glucosuria. Among 51 patients treated for 1–10 (mean 7.4) years with adefovir (n = 42), tenofovir (n = 4) or adefovir followed by tenofovir (n = 5), 7 (14%) developed RTD. Time to onset ranged from 22 to 94 (mean 49) months with an estimated 10-year cumulative rate of 15%. All seven had low urinary percent maximal tubular reabsorption of phosphate (<82%). Patients with RTD were older (58 vs. 44 years; P = 0.01) and had lower baseline glomerular filtration rates (82 vs. 97 cc/min; P = 0.08) compared to those without; but did not differ in other features. Six patients with RTD were switched to entecavir, all subsequently had improvements in serum phosphate (2.0–3.0 mg/dL), creatinine (1.6–1.1 mg/dL), uric acid (2.7 –3.8 mg/dL) and proteinuria. Renal tubular dysfunction develops in 15% of patients treated with adefovir or tenofovir for 2–9 years and is partially reversible with change to other antivirals. Monitoring for serum phosphate, creatinine and urinalysis is prudent during long-term adefovir and tenofovir therapy.
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DOI：
10.1111/j.1440-1746.2004.03428.x
发表时间：
2004-11-01
影响因子：
4.1
作者：
Chang, TT;Lai, CL;Leung, NW
通讯作者：
Leung, NW
影响因子：
13.5
作者：
Snow-Lampart, Andrea;Chappell, Brandi;Borroto-Esoda, Katyna
通讯作者：
Borroto-Esoda, Katyna
影响因子：
5.8
作者：
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通讯作者：
Econs, Michael J.
影响因子：
39.2
作者：
Levey, Andrew S.;Coresh, Josef;Van Lente, Frederick
通讯作者：
Van Lente, Frederick
影响因子：
158.5
作者：
Hadziyannis, SJ;Tassopoulos, NC;Brosgart, CL
通讯作者：
Brosgart, CL