Tenofovir-related acute kidney injury and proximal tubule dysfunction precipitated by diclofenac: a case of drug-drug interaction

Clin Nephrol. 2009 May;71(5):567-70. doi: 10.5414/cnp71567.

Abstract

We describe an HIV1-positive patient under long-term tenofovir treatment who developed a severe, biopsy-proven, acute tubular necrosis with proximal tubule (PT) dysfunction, precipitated by the very recent start of diclofenac, a nonsteroidal antiinflammatory drug (NSAID). Recent studies show that NSAIDs not only alter glomerular filtration but also multidrug resistance protein (MRP) 4-mediated PT secretion of several substrates. Since the patient tolerated tenofovir well for several years prior to diclofenac use, our observation suggests that diclofenac interfered with tenofovir clearance, thereby favoring its nephrotoxicity. NSAIDs should be avoided in patients under tenofovir.

Publication types

  • Case Reports

MeSH terms

  • Acute Kidney Injury / chemically induced*
  • Acute Kidney Injury / pathology
  • Adenine / adverse effects
  • Adenine / analogs & derivatives*
  • Adenine / therapeutic use
  • Anti-HIV Agents / adverse effects
  • Anti-HIV Agents / therapeutic use
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Biopsy
  • Diagnosis, Differential
  • Diclofenac / adverse effects*
  • Diclofenac / therapeutic use
  • Drug Synergism
  • Drug Therapy, Combination
  • Fanconi Syndrome / chemically induced*
  • Fanconi Syndrome / pathology
  • Female
  • HIV Antibodies / immunology*
  • HIV Seropositivity / drug therapy*
  • HIV Seropositivity / virology
  • HIV-1 / immunology*
  • Humans
  • Kidney Tubules, Proximal / drug effects
  • Kidney Tubules, Proximal / pathology
  • Middle Aged
  • Organophosphonates / adverse effects*
  • Organophosphonates / therapeutic use
  • Tenofovir

Substances

  • Anti-HIV Agents
  • Anti-Inflammatory Agents, Non-Steroidal
  • HIV Antibodies
  • Organophosphonates
  • Diclofenac
  • Tenofovir
  • Adenine