Drug-induced Fanconi syndrome in patients with kidney allograft transplantation

作者：Zhouqi Tang, Tengfang Li, Helong Dai, Feng Chen, Xubiao Xie, Fenghua Peng, Gongbin Lan, Shaojie Yu, Yu Wang, Chunhua Fang, Manhua Nie, Xiao-Qiong Yuan, Xiaotian Tang, Xin Jiang, Xuejing Zhu, Yuxi Fan, Jiawei Peng, Siyu Sun, Mingda Zhong, Hedong Zhang, Longkai Peng · 发表于：Frontiers in Immunology · 年份：2022 · DOI：10.3389/fimmu.2022.979983 · 被引用次数：9 · 研究领域：Drug-Induced Hepatotoxicity and Protection、Renal Transplantation Outcomes and Treatments、HIV/AIDS drug development and treatment

Background: Patients after kidney transplantation need to take long-term immunosuppressive and other drugs. Some of these drug side effects are easily confused with the symptoms of Fanconi syndrome, resulting in misdiagnosis and missed diagnosis, and causing serious consequences to patients. Therefore, improving awareness, early diagnosis and treatment of Fanconi syndrome after kidney transplantation is critical. Methods: This retrospective study analyzed 1728 cases of allogeneic kidney transplant patients admitted to the Second Xiangya Hospital of Central South University from July 2016 to January 2021. Two patients with Fanconi syndrome secondary to drugs, adefovir dipivoxil (ADV) and tacrolimus, were screened. We summarized the diagnostic process, clinical data, and prognosis. Results: The onset of Fanconi syndrome secondary to ADV after renal transplantation was insidious, and the condition developed after long-term medication (>10 years). It mainly manifested as bone pain, osteomalacia, and scoliosis in the late stage and was accompanied by obvious proximal renal tubular damage (severe hypophosphatemia, hypokalemia, hypocalcemia, hypouricemia, glycosuria, protein urine, acidosis, etc.) and renal function damage (increased creatinine and azotemia). The pathological findings included mitochondrial swelling and deformity in renal tubular epithelial cells. The above symptoms and signs were relieved after drug withdrawal, but the scoliosis was difficult to rectify. Fanconi sy...