Acute Kidney Injury/chemically induced/pathology; Adenine/adverse effects/analogs & derivatives/therapeutic use; Anti-HIV Agents/adverse effects/therapeutic use; Anti-Inflammatory Agents, Non-Steroidal/adverse effects/therapeutic use; Biopsy; Diagnosis, Differential; Diclofenac/adverse effects/therapeutic use; Drug Synergism; Drug Therapy, Combination; Fanconi Syndrome/chemically induced/pathology; Female; HIV Antibodies/immunology; HIV Seropositivity/drug therapy/virology; HIV-1/immunology; Humans; Kidney Tubules, Proximal/drug effects/pathology; Middle Aged; Phosphonic Acids/adverse effects/therapeutic use
Abstract :
[en] We describe an HIV1-positive patient under long-term tenofovir treatment who developed a severe, biopsy-proven, acute tubular necrosis with proximal tubule (PT) dysfunction, precipitated by the very recent start of diclofenac, a nonsteroidal antiinflammatory drug (NSAID). Recent studies show that NSAIDs not only alter glomerular filtration but also multidrug resistance protein (MRP) 4-mediated PT secretion of several substrates. Since the patient tolerated tenofovir well for several years prior to diclofenac use, our observation suggests that diclofenac interfered with tenofovir clearance, thereby favoring its nephrotoxicity. NSAIDs should be avoided in patients under tenofovir.
Disciplines :
Urology & nephrology
Author, co-author :
Morelle, J.
Labriola, L.
Lambert, Michel
Cosyns, J.-P.
JOURET, François ; Centre Hospitalier Universitaire de Liège - CHU > Néphrologie
Jadoul, M.
Language :
English
Title :
Tenofovir-related acute kidney injury and proximal tubule dysfunction precipitated by diclofenac: a case of drug-drug interaction.
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