Fanconi Syndrome — ESENeph MCQ

Correct answer: D — Tenofovir-associated proximal tubulopathy with Fanconi biochemical abnormalities

The best answer is “Tenofovir-associated proximal tubulopathy with Fanconi biochemical abnormalities”. Tenofovir disoproxil can injure proximal tubular mitochondria, causing phosphate, glucose, urate, bicarbonate, amino-acid and low-molecular-weight protein losses; the antiretroviral regimen requires specialist review. “HIV-associated collapsing glomerulopathy with heavy proteinuria and declining function” is less appropriate because that produces heavy glomerular proteinuria rather than generalized proximal solute wasting “Distal renal tubular acidosis with alkaline urine and nephrocalcinosis” is less appropriate because distal acidification failure does not cause glycosuria and phosphaturia “Diabetic nephropathy with albuminuria and progressive glomerular disease” is less appropriate because normoglycaemic glycosuria with multiple tubular losses points to proximal dysfunction “Renal-artery stenosis with renovascular hypertension and asymmetric kidneys” is less appropriate because this does not explain the Fanconi biochemical pattern

Reference: BHIVA guideline for treatment of HIV-1-positive adults: https://bhiva.org/clinical-guideline/hiv-1-treatment-guidelines/