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AIDS Research and Treatment
Volume 2011, Article ID 354908, 11 pages
http://dx.doi.org/10.1155/2011/354908
Review Article

Tenofovir Nephrotoxicity: 2011 Update

1Nefrología, IIS-Fundacion Jimenez Diaz, Fundacion Renal Iñigo Alvarez de Toledo/Instituto Reina Sofia de Investigacion Nefrologica (FRIAT/IRSIN), Universidad Autonoma de Madrid, Madrid, Spain
2Medicina Interna, IIS-Fundacion Jimenez Diaz, Madrid, Spain
3Nefrología, IDiPaz, Universidad Autonoma de Madrid, Fundacion Renal Iñigo Alvarez de Toledo/Instituto Reina Sofia de Investigacion Nefrologica (FRIAT/IRSIN), Madrid, Spain
4Unidad de Diálisis, Fundación Jiménez Díaz, Avenida Reyes Católicos 2, 28040 Madrid, Spain

Received 31 January 2011; Accepted 4 April 2011

Academic Editor: Robert R. Redfield

Copyright © 2011 Beatriz Fernandez-Fernandez et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Tenofovir is an acyclic nucleotide analogue reverse-transcriptase inhibitor structurally similar to the nephrotoxic drugs adefovir and cidofovir. Tenofovir is widely used to treat HIV infection and approved for treatment of hepatitis B virus. Despite initial cell culture and clinical trials results supporting the renal safety of tenofovir, its clinical use is associated with a low, albeit significant, risk of kidney injury. Proximal tubular cell secretion of tenofovir explains the accumulation of the drug in these mitochondria-rich cells. Tenofovir nephrotoxicity is characterized by proximal tubular cell dysfunction that may be associated with acute kidney injury or chronic kidney disease. Withdrawal of the drug leads to improvement of analytical parameters that may be partial. Understanding the risk factors for nephrotoxicity and regular monitoring of proximal tubular dysfunction and serum creatinine in high-risk patients is required to minimize nephrotoxicity. Newer, structurally similar molecular derivatives that do not accumulate in proximal tubules are under study.