Adefovir dipivoxil-induced Fanconi syndrome and its predictive factors: A study of 28 cases

  • Authors:
    • Yong Lin
    • Fan Pan
    • Yingchao Wang
    • Ziqian Chen
    • Chun Lin
    • Lvfeng Yao
    • Xin Zhang
    • Rui Zhou
    • Chen Pan
  • View Affiliations

  • Published online on: November 17, 2016     https://doi.org/10.3892/ol.2016.5393
  • Pages: 307-314
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Abstract

The aim of the present study was to identify monitoring and prevention measures as well as predictive factors for early detection of renal toxicity associated with long‑term administration of adefovir dipivoxil in order to avoid progression to Fanconi syndrome. Clinical data of 28 patients with Fanconi syndrome caused by long-term administration of adefovir dipivoxil for the treatment of chronic hepatitis B virus (HBV) infection were collected pre‑and post-administration for analysis. Patients presented with fatigue, progressive systemic pain in multiple bones and joints, as well as difficulty in walking and pathological fractures in a number of severe cases. Laboratory examinations revealed hypophosphatemia, elevated serum cystatin C (Cys-C), elevated serum creatinine (SCr), reduced glomerular filtration rate (GFR), positive urinary protein, erythrocytes and glucose, as well as osteoporosis. In consequence, adefovir dipivoxil administration was stopped, and patients received concentrated divitamins, sodium phosphate syrup and calcitriol. Symptoms and abnormalities in laboratory examinations were significantly improved in all patients after 2-6 months. Therefore, serum phosphate, SCr, routine urine parameters, Cys‑C and GFR should be monitored regularly in chronic HBV patients treated with adefovir dipivoxil. The following factors were identified as predictive of kidney damage and Fanconi syndrome: Age ≥40 years, living in rural areas, previous renal toxicity, estimated GFR (eGFR) <90 ml/min/1.73 m2, hypertension, diabetes, cirrhosis and duration of adefovir dipivoxil treatment exceeding 24 months. The present results indicate that timely termination of adefovir dipivoxil treatment and replacement with other antiviral agents is critical once renal impairment appears, and that it is necessary to change to other antiviral agents and prolong the interval of administration according to the eGFR level.
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January-2017
Volume 13 Issue 1

Print ISSN: 1792-1074
Online ISSN:1792-1082

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Spandidos Publications style
Lin Y, Pan F, Wang Y, Chen Z, Lin C, Yao L, Zhang X, Zhou R and Pan C: Adefovir dipivoxil-induced Fanconi syndrome and its predictive factors: A study of 28 cases. Oncol Lett 13: 307-314, 2017.
APA
Lin, Y., Pan, F., Wang, Y., Chen, Z., Lin, C., Yao, L. ... Pan, C. (2017). Adefovir dipivoxil-induced Fanconi syndrome and its predictive factors: A study of 28 cases. Oncology Letters, 13, 307-314. https://doi.org/10.3892/ol.2016.5393
MLA
Lin, Y., Pan, F., Wang, Y., Chen, Z., Lin, C., Yao, L., Zhang, X., Zhou, R., Pan, C."Adefovir dipivoxil-induced Fanconi syndrome and its predictive factors: A study of 28 cases". Oncology Letters 13.1 (2017): 307-314.
Chicago
Lin, Y., Pan, F., Wang, Y., Chen, Z., Lin, C., Yao, L., Zhang, X., Zhou, R., Pan, C."Adefovir dipivoxil-induced Fanconi syndrome and its predictive factors: A study of 28 cases". Oncology Letters 13, no. 1 (2017): 307-314. https://doi.org/10.3892/ol.2016.5393