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Jiang SX, Duncan J, Ko HH. Acquired Fanconi Syndrome from Tenofovir Treatment in a Patient with Hepatitis B. Case Reports Hepatol 2023; 2023:6158407. [PMID: 37362623 PMCID: PMC10290559 DOI: 10.1155/2023/6158407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 06/28/2023] Open
Abstract
Fanconi syndrome is a rare disease of generalized proximal tubule dysfunction which can be acquired secondary to certain medications, including tenofovir, a commonly used hepatitis B treatment. Signs and symptoms of ensuing renal wasting can be severe but vague, leading to potentially avoidable invasive investigations and delays in diagnosis. We present a case of a 62-year-old female with chronic hepatitis B on tenofovir treatment who was found to have subacute weakness, anorexia, and weight loss. She underwent extensive investigations including computed tomography (CT) imaging, bronchoscopy, upper and lower endoscopy, and psychiatric evaluation. Finally, persistent electrolyte derangements led to urine studies, which demonstrated acquired Fanconi syndrome secondary to tenofovir. After discontinuing tenofovir disoproxil fumarate and starting tenofovir alafenamide, her symptoms resolved and her renal function recovered. This case illustrates the importance of maintaining clinical suspicion for tenofovir-induced Fanconi syndrome, given the common use of tenofovir as first-line hepatitis B treatment and the availability of less nephrotoxic alternatives.
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Affiliation(s)
- Shirley X. Jiang
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - John Duncan
- Division of Nephrology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Hin Hin Ko
- Division of Gastroenterology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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2
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Li Y, Chen X, Wang B, Liu X, Hou S. Sporadic hypophosphatemic osteomalacia combined with psoriasis: A rare case report and a brief review of the literature. Int J Rheum Dis 2023; 26:968-972. [PMID: 36625293 DOI: 10.1111/1756-185x.14562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 12/27/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND Hypophosphatemic osteomalacia (HO) is an unusual metabolic disease characterized by low concentrations of serum phosphate levels, which leads to reduced mineralization of the bone matrix. Typically, HO consists of 4 common types: X-linked dominant hypophosphatemia (XLH), autosomal dominant hypophosphatemic rickets (ADHR), tumor-induced osteomalacia (TIO), and sporadic HO. CASE PRESENTATION We herein report the case of a 48-year-old man who developed multiple joint and bone pain and muscle weakness over 5 months with a 23-year history of psoriasis. He was diagnosed with psoriatic arthritis by primary hospitals but was unresponsive to etanercept and adalimumab treatments. After referral to our hospital, the patient was diagnosed with HOs combined with psoriasis. The patient was treated with oral phosphate solution, calcium, and active vitamin D, and the symptoms of bone and joint pain and muscle weakness gradually relieved. Since TIO accounts for the majority of adult-onset HO, positron emission tomography - computed tomography or octreotide imaging examinations had been done yearly to locate any underlying tumor in our patient, with negative findings in the 4-year follow-up. CONCLUSIONS Diagnosis of HO remains a challenge to rheumatologists, and especially to dermatologists when accompanied by psoriasis. After excluding the inherited HO and with negative tumor, this report may be the first male case of sporadic HO combined with psoriasis.
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Affiliation(s)
- Yuan Li
- Department of Dermatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Xiaohong Chen
- Department of Dermatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Bin Wang
- Department of Dermatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Xiaoming Liu
- Department of Dermatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Suchun Hou
- Department of Dermatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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Pearson A, Haenni D, Bouitbir J, Hunt M, Payne BAI, Sachdeva A, Hung RKY, Post FA, Connolly J, Nlandu-Khodo S, Jankovic N, Bugarski M, Hall AM. Integration of High-Throughput Imaging and Multiparametric Metabolic Profiling Reveals a Mitochondrial Mechanism of Tenofovir Toxicity. FUNCTION (OXFORD, ENGLAND) 2022; 4:zqac065. [PMID: 36654930 PMCID: PMC9840465 DOI: 10.1093/function/zqac065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 12/26/2022]
Abstract
Nephrotoxicity is a major cause of kidney disease and failure in drug development, but understanding of cellular mechanisms is limited, highlighting the need for better experimental models and methodological approaches. Most nephrotoxins damage the proximal tubule (PT), causing functional impairment of solute reabsorption and systemic metabolic complications. The antiviral drug tenofovir disoproxil fumarate (TDF) is an archetypal nephrotoxin, inducing mitochondrial abnormalities and urinary solute wasting, for reasons that were previously unclear. Here, we developed an automated, high-throughput imaging pipeline to screen the effects of TDF on solute transport and mitochondrial morphology in human-derived RPTEC/TERT1 cells, and leveraged this to generate realistic models of functional toxicity. By applying multiparametric metabolic profiling-including oxygen consumption measurements, metabolomics, and transcriptomics-we elucidated a highly robust molecular fingerprint of TDF exposure. Crucially, we identified that the active metabolite inhibits complex V (ATP synthase), and that TDF treatment causes rapid, dose-dependent loss of complex V activity and expression. Moreover, we found evidence of complex V suppression in kidney biopsies from humans with TDF toxicity. Thus, we demonstrate an effective and convenient experimental approach to screen for disease relevant functional defects in kidney cells in vitro, and reveal a new paradigm for understanding the pathogenesis of a substantial cause of nephrotoxicity.
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Affiliation(s)
- Adam Pearson
- Institute of Anatomy, University of Zurich, Winterthurerstrasse 190, CH-8057 Zurich, Switzerland
| | - Dominik Haenni
- Center for Microscopy and Image Analysis, University of Zurich, Winterthurerstrasse 190, CH-8057 Zurich, Switzerland
| | - Jamal Bouitbir
- Division of Molecular and Systems Toxicology, Department of Pharmaceutical Sciences, University of Basel, Klingelbergstrasse 50, CH-4056 Basel, Switzerland
| | - Matthew Hunt
- Wellcome Centre for Mitochondrial Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Brendan A I Payne
- Wellcome Centre for Mitochondrial Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK,Department of Infection and Tropical Medicine, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
| | - Ashwin Sachdeva
- Genito-Urinary Cancer Research Group, Division of Cancer Sciences, University of Manchester, Manchester, M20 4GJ, UK,Department of Surgery, The Christie Hospital NHS Foundation Trust, 550 Wilmslow Road, Manchester M20 4BX, UK
| | - Rachel K Y Hung
- King’s College Hospital and School of Immunology & Microbial Sciences, King’s College London, London, SE5 8AF, UK
| | - Frank A Post
- King’s College Hospital and School of Immunology & Microbial Sciences, King’s College London, London, SE5 8AF, UK
| | - John Connolly
- UCL Centre for Nephrology, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK
| | - Stellor Nlandu-Khodo
- Institute of Physiology, University of Zurich, Winterthurerstrasse 190, CH-8057 Zurich, Switzerland
| | - Nevena Jankovic
- Institute of Anatomy, University of Zurich, Winterthurerstrasse 190, CH-8057 Zurich, Switzerland
| | - Milica Bugarski
- Institute of Anatomy, University of Zurich, Winterthurerstrasse 190, CH-8057 Zurich, Switzerland
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Pérez‐Pinzón J, Olin RL, Banerjee R. Severe electrolyte derangements from lysozymuria in acute myeloid leukemia. EJHAEM 2022; 3:1018-1020. [PMID: 36051078 PMCID: PMC9421957 DOI: 10.1002/jha2.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/11/2022] [Accepted: 04/20/2022] [Indexed: 11/28/2022]
Abstract
Renal dysfunction in patients with acute myeloid leukemia (AML) can be multifactorial. We present the case of a 72‐year‐old male with relapsed myelomonocytic AML who presented with transient acute kidney injury (AKI) and severe persistent electrolyte derangements. In the setting of nephrotic‐range proteinuria and electrolyte wasting without significant albuminuria or glucosuria, a diagnosis of lysozymuria was made. Lysozymuria is a rare paraneoplastic complication of AML and chronic myelomonocytic leukemia characterized by lysozyme. This represents the first case of lysozymuria presenting primarily with refractory electrolyte derangements rather than severe AKI. Lysozymuria portends a poor clinical prognosis even with aggressive management.
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Affiliation(s)
| | - Rebecca L. Olin
- Department of Medicine Division of Hematology/Oncology University of California San Francisco San Francisco California USA
| | - Rahul Banerjee
- Department of Medicine Division of Hematology/Oncology University of California San Francisco San Francisco California USA
- Department of Medicine Division of Medical Oncology University of Washington School of Medicine Seattle Washington USA
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Wan ER, Siew K, Heptinstall L, Walsh SB. Fumaric acid ester-induced renal Fanconi syndrome: evidence of mitochondrial toxicity. Clin Kidney J 2021; 14:2085-2089. [PMID: 35261762 PMCID: PMC8894934 DOI: 10.1093/ckj/sfaa270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/14/2020] [Indexed: 12/24/2022] Open
Abstract
Background Fumaric acid esters (FAEs) are used to treat chronic plaque psoriasis. Fumarate is a crucial component of the Krebs cycle and mitochondrial function. Proximal tubule cells have high energy demands and rely on aerobic respiration. Proximal tubular dysfunction can cause renal Fanconi syndrome and acute kidney injury. We sought to better understand the mechanism for this in the context of FAE therapy. Methods We describe a case series of 10 patients with FAE-associated Fanconi syndrome. Patients were diagnosed and managed at a tertiary renal tubular disorder clinic, with examination of serum and urine biochemistry. Five patients had a renal biopsy with examination of the specimens by electron microscopy. Results The median age was 36.5 years [interquartile range (IQR) 32.25–54.25]. The median dose of FAE was 720 mg/day (IQR 390–720). There was low molecular weight proteinuria: the median urinary retinol-binding protein (RBP) at presentation was 8385 μg/mL (IQR 2793–14 600) and the RBP:creatinine ratio was 710 (IQR 390–2415). All patients had hyperphosphaturia [median fractional excretion of phosphate 24.2% (IQR 20.8–26.9), normal range <20%] as well as relative hypophosphataemia, with a median serum phosphate concentration of 0.93 mmol/L (IQR 0.83–0.97). Renal histology showed proximal tubular damage and abnormal mitochondrial morphology. Two patients had a favourable biochemical response to treatment with probenecid. Conclusions We document for the first time that FAE-associated renal Fanconi syndrome is associated with mitochondrial damage visible on electron microscopy. This effect may be ameliorated by antagonism of the organic anion transporter with probenecid.
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Affiliation(s)
- Elizabeth R Wan
- Department of Renal Medicine, Royal Free Hospital, University College London, London, UK
| | - Keith Siew
- Department of Renal Medicine, Royal Free Hospital, University College London, London, UK
| | - Lauren Heptinstall
- Department of Renal Medicine, Royal Free Hospital, University College London, London, UK
| | - Stephen B Walsh
- Department of Renal Medicine, Royal Free Hospital, University College London, London, UK
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Traish AM. Post-finasteride syndrome: a surmountable challenge for clinicians. Fertil Steril 2020; 113:21-50. [PMID: 32033719 DOI: 10.1016/j.fertnstert.2019.11.030] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/04/2019] [Accepted: 11/25/2019] [Indexed: 12/28/2022]
Abstract
Post-finasteride syndrome (PFS) is a constellation of serious adverse side effects manifested in clinical symptoms that develop and persist in patients during and/or after discontinuing finasteride treatment in men with pattern hair loss (androgenetic alopecia) or benign prostatic hyperplasia. These serious adverse side effects include persistent or irreversible sexual, neurological, physical and mental side effects. To date, there are no evidence-based effective treatments for PFS. Although increasing number of men report persistent side effects, the medical community has yet to recognize this syndrome nor are there any specific measures to address this serious and debilitating symptoms. Here we evaluate the scientific and clinical evidence in the contemporary medical literature to address the very fundamental question: Is PFS a real clinical condition caused by finasteride use or are the reported symptoms only incidentally associated with but not caused by finasteride use? One key indisputable clinical evidence noted in all reported studies with finasteride and dutasteride was that use of these drugs is associated with development of sexual dysfunction, which may persist in a subset of men, irrespective of age, drug dose or duration of study. Also, increased depression, anxiety and suicidal ideation in a subset of men treated with these drugs were commonly reported in a number of studies. It is important to note that many clinical studies suffer from incomplete or inadequate assessment of adverse events and often limited or inaccurate data reporting regarding harm. Based on the existing body of evidence in the contemporary clinical literature, the author believes that finasteride and dutasteride induce a constellation of persistent sexual, neurological and physical adverse side effects, in a subset of men. These constellations of symptoms constitute the basis for PFS in individuals predisposed to epigenetic susceptibility. Indeed, delineating the pathophysiological mechanisms underlying PFS will be of paramount importance to the understanding of this syndrome and to development of potential novel therapeutic modalities.
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Affiliation(s)
- Abdulmaged M Traish
- Department of Urology, Boston University School of Medicine, Boston, Massachusetts.
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7
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Osteoporosis and Psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2019.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Muñoz-Torres M, Aguado P, Daudén E, Carrascosa JM, Rivera R. Osteoporosis and Psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:642-652. [PMID: 31151668 DOI: 10.1016/j.ad.2019.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 01/29/2019] [Accepted: 02/03/2019] [Indexed: 02/08/2023] Open
Abstract
Psoriasis is a chronic inflammatory disease associated with multiple comorbidities, particularly in patients with arthritis or more severe forms of the disease. The link between all these comorbidities is probably systemic inflammation. Several recent studies have indicated that patients with psoriasis may be at an increased risk of pathologic fractures and osteoporosis. Current guidelines on comorbidities in psoriasis do not recommend assessment of bone health. In this article, we review the available evidence on the association between psoriasis and osteoporosis. We first examine the concept of osteoporosis and the role of vitaminD in bone health and then propose an algorithm for managing and treating this condition in patients with psoriasis.
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Affiliation(s)
- M Muñoz-Torres
- Servicio de Endocrinología, Hospital Universitario San Cecilio, Granada, España
| | - P Aguado
- Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España
| | - E Daudén
- Servicio de Dermatología, Hospital Universitario La Princesa, Madrid, España
| | - J M Carrascosa
- Servicio de Dermatología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, España
| | - R Rivera
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España.
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The footprints of mitochondrial impairment and cellular energy crisis in the pathogenesis of xenobiotics-induced nephrotoxicity, serum electrolytes imbalance, and Fanconi's syndrome: A comprehensive review. Toxicology 2019; 423:1-31. [PMID: 31095988 DOI: 10.1016/j.tox.2019.05.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/29/2019] [Accepted: 05/09/2019] [Indexed: 12/19/2022]
Abstract
Fanconi's Syndrome (FS) is a disorder characterized by impaired renal proximal tubule function. FS is associated with a vast defect in the renal reabsorption of several chemicals. Inherited and/or acquired conditions seem to be connected with FS. Several xenobiotics including many pharmaceuticals are capable of inducing FS and nephrotoxicity. Although the pathological state of FS is well described, the exact underlying etiology and cellular mechanism(s) of xenobiotics-induced nephrotoxicity, serum electrolytes imbalance, and FS are not elucidated. Constant and high dependence of the renal reabsorption process to energy (ATP) makes mitochondrial dysfunction as a pivotal mechanism which could be involved in the pathogenesis of FS. The current review focuses on the footprints of mitochondrial impairment in the etiology of xenobiotics-induced FS. Moreover, the importance of mitochondria protecting agents and their preventive/therapeutic capability against FS is highlighted. The information collected in this review may provide significant clues to new therapeutic interventions aimed at minimizing xenobiotics-induced renal injury, serum electrolytes imbalance, and FS.
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Gu X, Chen M, Xu Y, Wang Y. Acquired renal glucosuria in an undifferentiated connective tissue disease patient with a SLC5A2 heterozygous mutation: A case report. Medicine (Baltimore) 2018; 97:e13664. [PMID: 30558067 PMCID: PMC6319971 DOI: 10.1097/md.0000000000013664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Renal glucosuria is a renal tubular disorder caused by genetic conditions, drugs, and poisons. Mutations in the SLC5A2 gene are recently found to be responsible for the inherited renal glucosuria, while undifferentiated connective tissue disease (UCTD) was not considered pathogenic for renal glucosuria. Here, we present a case of acquired renal glucosuria in a UCTD patient. PATIENT CONCERNS A 30-year-old woman was seen in the outpatient clinic for complaints of frequent urination and dysuria. Laboratory tests showed a urinary tract infection (UTI) and persistent renal glucosuria. After antibiotic treatment, the UTI symptoms were relieved, but the renal glucosuria remained. DIAGNOSIS Laboratory tests ruled out renal tubular acidosis and diabetes mellitus. Genetic analysis showed a heterozygous mutations in the SLC5A2 gene. Meanwhile, immunological tests showed a high antinuclear antibody titer (1:160) and an elevated anti-Rho/SSA antibody level. Schirmer test, tear breakup time, and lip biopsy results were all negative. The patient did not meet the criteria for any known connective diseases. Therefore, she was diagnosed with UCTD. INTERVENTIONS The patient was started with the treatment of Hydroxychloroquine. OUTCOMES Hydroxychloroquine treatment resolved the renal glucosuria. The patient's follow- up urinalysis showed no glucosuria at all. LESSONS This is the first case report to demonstrate that UCTD may induce renal glucosuria in a patient with a heterozygous mutation in SLC5A2. This case suggests that during the process of diagnosing renal glucosuria, in addition to familial renal glucosuria (FRG), autoimmune diseases, though rare, should also be taken into consideration.
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Tzaneva S, Geroldinger A, Trattner H, Tanew A. Fumaric acid esters in combination with a 6-week course of narrowband ultraviolet B provides an accelerated response compared with fumaric acid esters monotherapy in patients with moderate-to-severe plaque psoriasis: a randomized prospective clinical stud. Br J Dermatol 2018; 178:682-688. [DOI: 10.1111/bjd.16106] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2017] [Indexed: 02/06/2023]
Affiliation(s)
- S. Tzaneva
- Department of Dermatology; Division of General Dermatology and Dermato-Oncology; Medical University of Vienna; Vienna Austria
| | - A. Geroldinger
- Center for Medical Statistics, Informatics and Intelligent Systems; Section for Clinical Biometrics; Medical University of Vienna; Vienna Austria
| | - H. Trattner
- Department of Dermatology; Division of General Dermatology and Dermato-Oncology; Medical University of Vienna; Vienna Austria
| | - A. Tanew
- Department of Dermatology; Division of General Dermatology and Dermato-Oncology; Medical University of Vienna; Vienna Austria
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Perrone D, Afridi F, King-Morris K, Komarla A, Kar P. Proximal Renal Tubular Acidosis (Fanconi Syndrome) Induced by Apremilast: A Case Report. Am J Kidney Dis 2017; 70:729-731. [PMID: 28823583 DOI: 10.1053/j.ajkd.2017.06.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 06/22/2017] [Indexed: 12/17/2022]
Abstract
Apremilast is a recently developed phosphodiesterase 4-inhibitory medication approved for use to treat psoriasis and psoriatic arthritis. We report a case of Fanconi syndrome and proximal renal tubular acidosis that was associated with this medication. Our patient was started on treatment with apremilast 2 weeks before his admission. On arrival, laboratory test results were significant for hypokalemia, hyperchloremic metabolic acidosis, low uric acid concentration, positive urine anion gap, and proteinuria, which resolved on discontinuation of the drug. Two months after the hospitalization, he was restarted on apremilast therapy; 17 days after resumption, the patient was admitted for similar laboratory values, which again improved when apremilast treatment was discontinued. After discharge, laboratory values remained normal without long-term electrolyte repletion. Proximal renal tubular acidosis (Fanconi syndrome) with quick correction of electrolyte concentrations on discontinuation of the drug was diagnosed. Our patient lacked evidence of other causes. Our patient fulfilled criteria associated with this disease and responded well off treatment with the offending agent. Literature review did not reveal prior cases associated with this medication.
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Affiliation(s)
- Dana Perrone
- University of Central Florida/HCA Graduate Medical Education Consortium Internal Medicine Residency Program, Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, FL.
| | - Faraz Afridi
- University of Central Florida/HCA Graduate Medical Education Consortium Internal Medicine Residency Program, Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, FL
| | | | - Ashwini Komarla
- Department of Rheumatology, Orlando VA Medical Center, Orlando, FL
| | - Pran Kar
- Department of Nephrology, Orlando VA Medical Center, Orlando, FL
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Menzies S, Ismail N, Abdalla A, Collins P, Kirby B, Holian J, Lally A. Renal dysfunction in patients taking fumaric acid esters - a retrospective cross-sectional study. J Eur Acad Dermatol Venereol 2016; 31:686-691. [DOI: 10.1111/jdv.14025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 10/17/2016] [Indexed: 11/29/2022]
Affiliation(s)
- S. Menzies
- Department of Dermatology; St. Vincent's University Hospital; Dublin 4 Ireland
| | - N. Ismail
- Department of Dermatology; St. Vincent's University Hospital; Dublin 4 Ireland
| | - A. Abdalla
- Department of Nephrology; St. Vincent's University Hospital; Dublin 4 Ireland
| | - P. Collins
- Department of Dermatology; St. Vincent's University Hospital; Dublin 4 Ireland
| | - B. Kirby
- Department of Dermatology; St. Vincent's University Hospital; Dublin 4 Ireland
| | - J. Holian
- Department of Nephrology; St. Vincent's University Hospital; Dublin 4 Ireland
| | - A. Lally
- Department of Dermatology; St. Vincent's University Hospital; Dublin 4 Ireland
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