SHM Converge Scientific Abstract ePoster Gallery-A Tubular Tale: Tenofovir Induced Fanconi Syndrome

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Tenofovir is widely used to treat HIV and hepatitis B, but it can rarely cause Fanconi syndrome, a proximal tubular disorder marked by hypophosphatemia, glycosuria, proteinuria, and metabolic acidosis. In this case, the diagnosis was supported by improvement in phosphate and bicarbonate levels after tenofovir was stopped.<br /><br />The proposed mechanism begins with tenofovir uptake into proximal tubular cells through organic anion transporters (OATs). Once inside the cell, tenofovir accumulates and causes mitochondrial damage, leading to impaired energy metabolism. This mitochondrial toxicity disrupts transporters responsible for reabsorption of phosphate and bicarbonate, specifically the sodium-phosphate cotransporter and sodium-bicarbonate cotransporter. As a result, the kidney loses phosphate and bicarbonate, producing the characteristic biochemical abnormalities of Fanconi syndrome.<br /><br />The literature supports this association. A review by Wassner et al. describes the differences between tenofovir disoproxil fumarate and tenofovir alafenamide and their renal effects. Medland et al. reported that Fanconi syndrome occurs more often when tenofovir is combined with ritonavir than when used alone. Li et al. also described severe hypophosphatemia and osteomalacia in a patient on long-term tenofovir, with improvement after drug discontinuation, similar to this patient’s rapid recovery.<br /><br />Overall, this case highlights tenofovir-induced Fanconi syndrome as an uncommon but clinically important adverse effect. Early recognition and discontinuation of the drug can lead to stabilization and recovery of renal tubular function.

Asset Subtitle

Bryan A. Velez

Meta Tag

Author List Bryan A. Velez, Matthew Shaines

Category Clinical Vignettes

Concept Tenofovir

Concept Fanconi Syndrome

Concept Mitochondrial Damage

Concept Hypophosphatemia

Concept Proximal Tubular Cell

Distinguished Non-Finalist

Presenter Organization Montefiore Medical Center/Albert Einstein College of Medicine

Presenting Author Bryan A. Velez

Track Adult

Keywords

tenofovir

Fanconi syndrome

proximal tubular disorder

hypophosphatemia

glycosuria

proteinuria

metabolic acidosis

mitochondrial toxicity

organic anion transporters

renal tubular dysfunction

Tenofovir

Fanconi Syndrome

Mitochondrial Damage

Hypophosphatemia

Proximal Tubular Cell