替诺福韦的肾毒性的最新进展

肝胆速递

Pediatr Nephrol. 2012 Aug 10. [Epub ahead of print]

Update on tenofovir toxicity in the kidney.
替诺福韦的肾毒性的最新进展

Hall AM.
Source

UCL Centre for Nephrology, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK, [email protected].
Abstract

Tenofovir (TFV) is a widely used and effective treatment for HIV infection. Numerous studies have shown that TFV exposure is associated with small but significant declines in estimated glomerular filtration rate (eGFR). However, TFV toxicity is targeted mainly at the proximal tubule (PT), and in severe cases can cause the renal Fanconi syndrome or acute kidney injury. Severe toxicity occurs in a minority of patients, but milder PT dysfunction is more common; the long-term significance of this on kidney and bone health is uncertain. Recent work suggests that changes in eGFR on TFV therapy might be explained by inhibition of PT creatinine secretion rather than actual alterations in glomerular function. Risk factors for nephrotoxicity include pre-existing kidney disease, increased age, and low body mass. Mitochondria in the PT are the targets of TFV toxicity, but the exact mechanisms remain unclear. Substantial improvement of renal function occurs in many patients with TFV toxicity upon stopping therapy, but function does not always return to baseline. In recent years, TFV usage has been extended to new clinical spheres, including pediatrics, resource-poor settings and treatment of Hepatitis B infection; theoretical reasons exist as to why some of these patients might be at higher or lower risk of TFV toxicity. Finally, strategies have been proposed to prevent TFV toxicity or enhance recovery.

肝胆速递

儿科杂志Nephrol。 2012年8月10日。 [EPUB的提前打印]
替诺福韦的肾毒性的最新进展。
霍尔。
源

伦敦大学肾脏病中心，英国NW32PF，伦敦皇家自由医院，罗兰·希尔街，andrew.hall ucl.ac.uk.
抽象

替诺福韦（TFV）是一种广泛使用的和有效的治疗HIV感染。大量的研究表明，TFV暴露与小但显着的下降，估计肾小球滤过率（eGFR）。然而，TFV毒性的目标主要在近曲小管（PT），在严重的情况下可能会导致肾功能的范可尼综合征或急性肾损伤。少数患者会出现严重的毒性反应，但较温和的的PT功能障碍是较常见的肾脏和骨骼健康的长远意义，这是不确定的。最近的研究工作表明，TFV治疗EGFR表达变化可能被解释为PT肌酐分泌的抑制而不是实际的改变，肾小球功能。肾毒性的危险因素包括预先存在肾脏疾病，年龄的增加，和低体重。线粒体的PT的目标是的TFV毒性，但确切的机制尚不清楚。发生在TFV毒性许多患者停止治疗后，但其功能并不总是恢复到基线显着改善肾功能。近年来，TFV使用已经扩展到新的临床领域，包括儿科，资源贫乏和治疗B型肝炎感染存在理论上的原因，为何一些患者可能是在较高或较低风险的TFV毒性。最后，策略被提出，以防止TFV毒性或提高采收率。

咬牙硬挺

吃还是不吃，这是一个问题

MP4

咬牙硬挺 发表于 2012-8-30 18:31
吃还是不吃，这是一个问题

莎士比亚说：To be, or not to be - that is the question

我看是活着比较好。