Abstract

TENOFOVIR-INDUCED ACUTE KIDNEY INJURY IN A PATIENT ON LONG-TERM TLD THERAPY: A CASE REPORT

Lingineni Mani Deepa Chandrika*, Niharika Vommi, Singuluri Monica, Konagala Arudra, Yakkala Chaturya Deepthi, Uma Maheswari Vuyyala, Shaik Ayesha Laharin

ABSTRACT

Tenofovir is a common antiretroviral agent that is employed in the management of HIV infection; nevertheless, its long-term use may result in kidney dysfunction and acute kidney injury (AKI). Here we describe the case of a 54-year-old lady who was admitted in the nephrology department with complaints of bilateral edema of lower limbs for the last one week and face puffiness for three days. She had been diagnosed with type 2 diabetes mellitus, hypertension, and retroviral disease (RVD) on tenofovir-based TLD for the past ten years. On examination, lab investigations revealed raised serum creatinine levels (7.5 mg/dL), elevated blood urea levels (151 mg/dL), hyperphosphatemia, metabolic acidosis, anemia, and poor renal function indicative of acute kidney injury (AKI). Considering the medical history of the patient and clinical features, tenofovir-induced AKI was suspected. The patient was managed conservatively using supportive care, glycemic control, antihypertensive drugs, correction of metabolic imbalances, and renal monitoring. Repeat laboratory investigations showed progressive improvement of her renal indices while in the hospital. Considering time sequence, clinical findings, and absence of alternative etiology, the ADR was considered to be probable according to Naranjo causality assessment score. It clearly shows that regular monitoring of renal function is vital for people who are undergoing prolonged treatment with tenofovir in cases of co-morbid diseases like diabetes mellitus and hypertension.

Keywords: Tenofovir, acute kidney injury, nephrotoxicity, adverse drug reaction, HIV, pharmacovigilance, case report.