Acquired Fanconi Syndrome Associated With Prolonged Adefovir Dipivoxil Therapy in a Chronic Hepatitis B Patient
Acquired Fanconi Syndrome Associated With Prolonged Adefovir Dipivoxil Therapy in a Chronic Hepatitis B Patient
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DOI：
10.1097/mjt.0b013e31820c4b20
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发表时间：
2013-11-01
影响因子：
4.2
通讯作者：
Ho, Yiu Yan
中科院分区：
文献类型：
--
作者：
Law, Siu-tong;Li, Kin Kong;Ho, Yiu Yan
阿德福韦酯（ADV）是治疗慢性B型肝炎的常用抗病毒药物之一。肾毒性与剂量相关，发生在每日剂量>30 mg时。然而，现在越来越多的人认识到，每日剂量为10 mg时可能发生肾毒性。我们报告一例慢性B型肝炎患者发生获得性范可尼综合征，该患者已接受ADV治疗4年。她表现为进行性肌无力和全身性骨痛。实验室检查结果显示近端肾小管功能障碍，尤其是严重的低磷血症。低磷血症和近端肾小管功能障碍的诊断方法进行了讨论。从ADV转换为恩替卡韦后，她的症状和实验室检查结果恢复正常。获得性范可尼综合征可能与常规剂量的ADV有关，因此，长期接受ADV治疗的患者应定期监测肾功能和钙磷水平。
Adefovir dipivoxil (ADV) is one of the commonly used antiviral agents in the treatment of chronic hepatitis B infection. Nephrotoxicity is dose related and occurred at a daily dosage of >30 mg. However, it is now increasingly recognized that nephrotoxicity can occur at a daily dose of 10 mg. We present a case of acquired Fanconi syndrome in a patient with chronic hepatitis B who had been treated with ADV for 4 years. She presented with progressive muscle weakness and generalized bone pain. The laboratory results showed the feature of proximal renal tubule dysfunction, particularly severe hypophosphatemia. Diagnostic approach to hypophosphatemia and proximal renal tubular dysfunction is discussed. After switching over from ADV to entecavir, her symptoms and laboratory findings returned to normal. Acquired Fanconi syndrome can be associated with ADV at a conventional dosage, and therefore, patients treated with long-term ADV should have regular monitoring of renal function and calcium and phosphate levels.