Estadísticas

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    "titulo" => "Insuficiencia renal aguda y disfunción tubular proximal en paciente diagnosticado de infección VIH tratado con tenofovir"
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        "resumen" => "Tenofovir es un nuevo inhibidor de la transcriptasa inversa con buena actividad frente a cepas resistentes del virus de inmunodeficiencia humana (HIV), de estructura similar a adefovir y cidofovir. Con éstos se ha descrito la aparición de un defecto en el transporte de sustancias en el túbulo proximal. Los estudios in vitro y las primeras referencias clínicas sobre tenofovir indicaban que presentaba poca toxicidad a nivel renal, y que su toxicidad a nivel mitocondrial era escasa. No obstante se han descrito recientemente casos de disfunción tubular proximal e insuficiencia renal relacionados con el uso de este fármaco. Además tenofovir puede aumentar las concentraciones plasmáticas de didanosina, aumentando la toxicidad mitocondrial de ésta, y los inhibidores de la proteasa pueden provocar una acumulación de tenofovir en las células tubulares renales, pudiendo desarrollarse una tubulopatía proximal. Presentamos una paciente HIV positiva que había presentado complicaciones con el tratamiento con didanosina, que desarrolla un cuadro de insuficiencia renal aguda y tubulopatía proximal (glucosuria normoglucémica, acidosis metabólica hiperclorémica) tras el tratamiento con tenofovir. Aunque la nefrotoxicidad de este fármaco parece ser menos frecuente que con otros análogos de nucleósidos, la utilización de tenofovir en pacientes con disfunción renal subyacente, durante largos períodos de tiempo, o asociados a didanosina y/o inhibidores de la proteasa, podría asociarse a ésta toxicidad. Si se utiliza tenofovir en estos pacientes deben monitorizarse la aparición de signos de tubulopatía, además de vigilar la función renal y la aparición de signos de toxicidad mitocondrial, suspendiendo su utilización para evitar la progresión a insuficiencia renal avanzada."
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