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Tenofovir Nephrotoxicity — SCE Infectious Diseases MCQ

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HardHIV MedicineTenofovir NephrotoxicitySCE Infectious Diseases

A person with HIV taking tenofovir disoproxil develops falling eGFR, hypophosphataemia, normoglycaemic glycosuria and low-molecular-weight proteinuria. Which lesion unifies the findings?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Tenofovir-disoproxil proximal tubular toxicity causing a renal Fanconi syndrome

The best answer is “Tenofovir-disoproxil proximal tubular toxicity causing a renal Fanconi syndrome”. Tenofovir disoproxil can cause proximal tubular toxicity, producing phosphate wasting, normoglycaemic glycosuria and low-molecular-weight proteinuria. HIV immune-complex kidney disease causes a different glomerular syndrome, whereas diabetic glomerulosclerosis requires diabetes and is chiefly albuminuric. These features support renal Fanconi syndrome rather than a glomerular lesion.

Reference: BHIVA adult ART guideline: https://bhiva.org/clinical-guideline/hiv-1-treatment-guidelines/