RESUMO
Tenofovir (TDF) is an inhibitor of reverse transcriptase nucleotide analogue, although it has good tolerability and high anti-retroviral activity, its effect on the kidney has been a concern. OBJECTIVE: To describe a girl infected with HIV who presented Fanconi syndrome during antiretroviral therapy with TDF. CLINICAL CASE: We describe a HIV-1-infected girl, who after 18 months treatment with TDF presented loss of strength and pain of the lower extremities with functional impairment. Laboratory findings were consistent with Fanconi syndrome. Radiographs showed bilateral hip fracture and wrists. Full recovery of Fanconi syndrome was achieved four months after changing antiretroviral therapy. CONCLUSIONS: TDF-prescribing physicians must be prepared to detect signs and symptoms of renal dysfunction and immediately consider switching to another antiviral drug.
Assuntos
Fármacos Anti-HIV/efeitos adversos , Síndrome de Fanconi/induzido quimicamente , Raquitismo/induzido quimicamente , Tenofovir/efeitos adversos , Fármacos Anti-HIV/administração & dosagem , Criança , Síndrome de Fanconi/diagnóstico , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Tenofovir/administração & dosagemRESUMO
El tenofovir (TDF) es un inhibidor de la transcriptasa reversa análogo de nucleótidos, aunque tiene buena tolerabilidad y alta actividad antirretroviral, su efecto sobre el riñón ha sido un motivo de preocupación. Objetivo: Describir el caso de una niña infectada por VIH que presenta síntomas y hallazgos de laboratorio compatibles con un síndrome de Fanconi durante el tratamiento con TDF como parte de su terapia antirretroviral. Caso clínico: Niña infectada por el VIH-1, que después de 18 meses con el tratamiento con TDF presentó pérdida de fuerza y dolor de las extremidades inferiores con deterioro funcional. Los hallazgos de laboratorio fueron compatibles con el síndrome de Fanconi. Las radiografías mostraron fractura bilateral de cadera y muñecas. El síndrome de Fanconi se recuperó por completo cuatro meses después del cambio de terapia antirretroviral. Conclusiones: Los médicos que prescriben TDF deben estar preparados para detectar signos y síntomas indicativos de disfunción renal y considerar de inmediato el cambio del fármaco a otro antirretroviral.
Tenofovir (TDF) is an inhibitor of reverse transcriptase nucleotide analogue, although it has good tolerability and high anti-retroviral activity, its effect on the kidney has been a concern. Objective: To describe a girl infected with HIV who presented Fanconi syndrome during antiretroviral therapy with TDF. Clinical case: We describe a HIV-1-infected girl, who after 18 months treatment with TDF presented loss of strength and pain of the lower extremities with functional impairment. Laboratory findings were consistent with Fanconi syndrome. Radiographs showed bilateral hip fracture and wrists. Full recovery of Fanconi syndrome was achieved four months after changing antiretroviral therapy. Conclusions: TDF-prescribing physicians must be prepared to detect signs and symptoms of renal dysfunction and immediately consider switching to another antiviral drug.
Assuntos
Humanos , Feminino , Criança , Raquitismo/induzido quimicamente , Fármacos Anti-HIV/efeitos adversos , Síndrome de Fanconi/induzido quimicamente , Tenofovir/efeitos adversos , Infecções por HIV/tratamento farmacológico , Fármacos Anti-HIV/administração & dosagem , Síndrome de Fanconi/diagnóstico , Tenofovir/administração & dosagemRESUMO
The records of five neonates born to mothers treated with intravenously administered magnesium sulfate for tocolysis were retrospectively reviewed to assess the presence of radiographic, clinical, and biochemical abnormalities. Two infants had radiographic bony abnormalities; one had frank rachitic changes and dental enamel hypoplasia. One of these patients, as well as an additional infant, had transient hypocalcemia. We hypothesize that prolonged infusion of magnesium sulfate, especially when initiated during the second trimester, may lead to fetal parathyroid gland suppression with consequent abnormalities resembling rickets.
Assuntos
Sulfato de Magnésio/efeitos adversos , Trabalho de Parto Prematuro/prevenção & controle , Raquitismo/induzido quimicamente , Tocolíticos/efeitos adversos , Adulto , Cálcio/sangue , Feminino , Humanos , Recém-Nascido , Infusões Intravenosas , Magnésio/sangue , Sulfato de Magnésio/administração & dosagem , Gravidez , Estudos Retrospectivos , Tocolíticos/administração & dosagemRESUMO
Concentrations of serum alkaline phosphatase and total urinary hydroxyproline were measured in 36 children to study the effect of phenobarbital administration with respect to the development of rickets in patients receiving anticonvulsive medications over prolonged periods of time. Administration of phenobarbital led to the appearance of increased AP and HOP values very early in the course of treatment and without any obvious bone changes suggestive of rickets; a single large oral dose of vitamin D had no appreciable effects in restoring the biochemical derangement. On the other hand, the administration of vitamin D in a daily dose of 4,000 IU for a period of two months hampered the appearance, or restored already existing changes of latent rickets, in children receiving anticonvulsive medication. The results in the present study favor the concept that phenobarbital administration is implicated in the development of rickets. The need for simultaneous daily administration of supplements of vitamin D in subjects receiving anticonvulsive drugs is stressed.
Assuntos
Fosfatase Alcalina/sangue , Epilepsia/tratamento farmacológico , Hidroxiprolina/urina , Fenobarbital/efeitos adversos , Raquitismo/induzido quimicamente , Vitamina D/uso terapêutico , Adolescente , Osso e Ossos/metabolismo , Cálcio/sangue , Criança , Pré-Escolar , Colágeno/metabolismo , Quimioterapia Combinada , Feminino , Humanos , Assistência de Longa Duração , Masculino , Fenobarbital/administração & dosagem , Fenobarbital/uso terapêutico , Fósforo/sangue , Radiografia , Raquitismo/prevenção & controle , Vitamina D/administração & dosagem , Punho/diagnóstico por imagemRESUMO
Three children ranging from seven to 12 years of age from unrelated families were given long-term anticonvulsant therapy including acetazolamide (Diamox). These children had rickets and renal tubular acidosis. Investigations have suggested (1) secondary hyperparathyroidism due to hypocalcemia of rickets and (2) prolonged acetazolamide therapy were responsible for acidosis as a result of reduction of bicarbonate reabsorption in the kidney. A clear-cut recovery from acidosis and rickets was seen in two patients following medication with high doses of vitamin D, an oral supplement of phosphorus, and discontinuance of acetazolamide therapy.