Renal tubular dysfunction during long-term adefovir or tenofovir therapy in chro

StephenW

Aliment Pharmacol Ther. 2012 Apr 16. doi: 10.1111/j.1365-2036.2012.05093.x. [Epub ahead of print]
Renal tubular dysfunction during long-term adefovir or tenofovir therapy in chronic hepatitis B.Gara N, Zhao X, Collins MT, Chong WH, Kleiner DE, Jake Liang T, Ghany MG, Hoofnagle JH.
SourceLiver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA.

AbstractBACKGROUND: 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).
AIM: To assess the incidence of RTD during long-term nucleotide therapy of chronic hepatitis B.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
Published 2012. This article is a US Government work and is in the public domain in the USA.

StephenW

aliment药理疗法。 2012年4月16日。 DOI：10.1111/j.1365-2036.2012.05093.x。 [出处提前打印]
在长期阿德福韦或替诺福韦治疗慢性乙型肝炎的肾小管功能障碍
加拉氮，赵，柯林斯吨，创WH，克莱纳DE，杰克梁ţ，Ghany爵，Hoofnagle JH。
源

肝病科，国立糖尿病，消化道和肾脏疾病，美国马里兰州贝塞斯达，研究所。
抽象
背景：

阿德福韦和替诺福韦是核苷酸类似物作为长期治疗慢性乙型肝炎的副作用很少，但长期和高剂量疗法已被近端肾小管功能障碍（RTD）。
目的：

评估的RTD的发病率在长期治疗慢性乙型肝炎的核苷酸
方法：

共有51名患者正在治疗的临床中心，国立卫生研究院进行了研究。诊断的RTD所需的重新出现至少三五个特点：hypophosphataemia，hypouricaemia，血肌酐升高，蛋白尿或糖尿。
结果：

在1-10（平均7.4）年阿德福韦组（n = 42），替诺福韦治疗的51例患者（N = 4）或阿德福韦其次是泰诺福韦（N = 5），7（14％）开发的RTD。发病时间不等，从22日至94（平均49）个月，估计10年累积率15％。所有七个最大的磷酸盐（<82％）低尿％肾小管重吸收。 RTD的患者年龄较大（58  -  44岁，P = 0.01）和较低的基线肾小球滤过率（82  -  97毫升/分钟，P = 0.08）相比，那些没有，但没有在其他功能有所不同。六个RTD的患者，改用恩替卡韦，血磷随后有改善（2.0-3.0毫克/升），肌酐（1.6-1.1毫克/升），尿酸（2.7-3.8毫克/升）和蛋白尿。
结论：

肾小管功能障碍发展为2-9年与阿德福韦或替诺福韦治疗的患者的15％，并与其他抗病毒药物的变化是部分可逆的。血磷，肌酐，尿监测是在长期阿德福韦和替诺福韦治疗的审慎。

咬牙硬挺

替诺也不能随便用啦