Hypophosphatemic Osteomalacia Associated with Adefovir-induced Fanconi Syndrome Initially Diagnosed as Diabetic Kidney Disease and Vitamin D Deficiency

Intern Med. 2019 Mar 15;58(6):821-825. doi: 10.2169/internalmedicine.1698-18. Epub 2018 Oct 17.

Abstract

A 68-year-old man with type 2 diabetes mellitus and chronic hepatitis B infection was referred to the nephrology department before planned surgery for hepatocellular carcinoma. He had been receiving low-dose adefovir dipivoxil (ADV) for 11 years. Laboratory findings revealed impaired re-absorption in the proximal renal tubules. He had been diagnosed with diabetic kidney disease and osteomalacia due to vitamin D deficiency; thus, ADV was not discontinued until he was referred to us. In this case, concomitant diabetes mellitus and vitamin D deficiency might have prevented the early diagnosis of ADV-induced Fanconi syndrome.

Keywords: Fanconi syndrome; adefovir; diabetic kidney disease; osteomalacia; vitamin D deficiency.

Publication types

  • Case Reports

MeSH terms

  • Adenine / adverse effects
  • Adenine / analogs & derivatives*
  • Adenine / therapeutic use
  • Aged
  • Antiviral Agents / adverse effects*
  • Antiviral Agents / therapeutic use
  • Diabetes Mellitus, Type 2 / complications
  • Diabetic Nephropathies / diagnosis*
  • Diagnostic Errors
  • Fanconi Syndrome / chemically induced
  • Fanconi Syndrome / complications
  • Fanconi Syndrome / diagnosis*
  • Hepatitis B, Chronic / complications
  • Hepatitis B, Chronic / drug therapy
  • Humans
  • Hypophosphatemia / diagnosis*
  • Hypophosphatemia / etiology
  • Male
  • Organophosphonates / adverse effects*
  • Organophosphonates / therapeutic use
  • Osteomalacia / diagnosis*
  • Osteomalacia / etiology
  • Vitamin D Deficiency / diagnosis*

Substances

  • Antiviral Agents
  • Organophosphonates
  • Adenine
  • adefovir dipivoxil