Residual TDF Proximal Tubulopathy Post-Switch TAF — ESENeph MCQ

Correct answer: C — Proximal tubular dysfunction requiring renal and antiretroviral treatment review

The best answer is “Proximal tubular dysfunction requiring renal and antiretroviral treatment review”. Tenofovir disoproxil toxicity can be incomplete in recovery after long exposure. Current medicines, phosphate, bicarbonate, bone health and kidney trajectory require continued surveillance. “Diabetic nephropathy causing albuminuric progressive glomerular kidney disease” is less appropriate because generalized tubular solute wasting is not a glomerular diabetic pattern “Distal tubular acidosis causing alkaline urine and recurrent nephrolithiasis” is less appropriate because distal acidification failure does not cause phosphaturia and glycosuria “IgA nephropathy causing haematuria and mesangial immune-complex deposition” is less appropriate because IgA disease produces haematuria and glomerular proteinuria “Adaptive tubular handling during stable long-term tenofovir treatment” is less appropriate because persistent Fanconi features represent pathology and can progress

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