Abstract:

ABSTRACT   Objective: To explore the clinical and pathological characteristics of adefovir nephrotoxicity. Methodology: The clinical and pathological data of four patients with biopsy-proven adefovir nephrotoxicity due to hepatitis B were retrospectively analyzed.   Results: All of them were male with age from 34~44 years old. three patients had been history of hepatitis B for ten years and one had 20 years. They had received adefovir for 3 to 6 years. The duration of renal disease was 3 to 23 months. The levels of serum creatitine were slightly elevated (1.32~1.7mg/dl), with hypophosphatemia in one and hypourecimia in two cases. Three of them had proteinuria from 0.54g/d to 1.72g/d), and one patient had positive urine glucose. They had no hypoabulminemia, hyperlepidemia and heamaturia. Renal biopsy showed mild segmental mesangial proliferation with acute tubular lesion including flatted and occasional detached tubular epithelial cells in three patients. One was diagnosed as IgA nephropathy with flatted and occasional detached tubular epithelial cells. Three had mild chronic tubular atrophy and interstitial fibrosis. Electron microscopy examination showed that proximal tubular mitochondria were extremely enlarged and dysmorphic with loss and disorientation of their cristae. The patient diagnosied as IgAN had mesangial dense deposits. After withdrawing Adefovir, the level of serum creatinine returned to normal and stable. Conclusion: Adefovir-induced nephrotoxicity manifested by slightly elevated creatine with abnormal tubular dysfunction which could accompanied with IgA nephropathy. Histologic characteristics included proximal tubular mitochondria extremely enlarged and dysmorphic with loss and disorientation of their cristae.

Key words: adefovir  , nephrotoxicity , chronic hepatitis B , mitochondrial