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Akutes Nierenversagen und Hyperkalzämie unter tenofovirhaltiger antiretroviraler Therapie bei einer Patientin mit AIDS und Immunrekonstitutionssyndrom nach niedrigdosierter Vitamin-D-Substitution

Acute Renal Failure and Hypercalcemia in an AIDS Patient on Tenofovir and Low-Dose Vitamin D Therapy with Immune Reconstitution Inflammatory Syndrome

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Zusammenfassung

Hintergrund:

Tenofovirhaltige antivirale Therapie kann zu einer Tubulopathie mit Hypokalzämie und in seltenen Fällen zum akuten Nierenversagen führen. Andererseits ist ein Nierenversagen unter Hyperkalzämie durch Vitamin- D-Intoxikation auch bei HIV-Infizierten beschrieben. Die Autoren berichten über einen Fall mit reversiblem Nierenversagen bei Hyperkalzämie unter niedrigdosiertem Vitamin D bei einer HIV-infizierten Patientin unter tenofovirhaltiger hochdosierter antiretroviraler Therapie.

Fallbeschreibung:

Eine 31-jährige Patientin mit HIV-Infektion im Vollbild des Immundefekts (CDC C3) wurde bei progredienter Niereninsuffizienz und Hyperkalzämie unter antiretroviraler Therapie mit Tenofovir und Emtricitabin in Kombination mit Efavirenz stationär aufgenommen. Zusätzlich bestand eine niedrigdosierte Substitution mit Calcium (500 mg/d) und Vitamin D3 (25 μg/d) zur Osteoporoseprophylaxe bei systemischer Kortikosteroidtherapie.

Schlussfolgerung:

Unter tenofovirhaltiger antiretroviraler Therapie bei HIV-Infektion oder Hepatitis B sollte neben der empfohlenen Nierenfunktionsprüfung auch das Serumcalcium kontrolliert werden.

Abstract

Background:

Tenofovir-containing antiviral therapy might result in acute renal failure and is able to induce tubular dysfunction with hypocalcemia. On the other hand, hypercalcemia induced by intoxication with colecalciferol has been described to induce renal failure in HIV-positive individuals as well. Here, the authors describe the unusual case of reversible renal failure due to hypercalcemia in a patient with low-dose colecalciferol substitution treated with tenofovir.

Case Report:

A 31-year-old HIV-positive female, CDC stage C3, was admitted to the authors’ hospital with progressive renal failure and hypercal- cemia. Antiretroviral therapy consisted of tenofovir and emtricitabine in combination with efavirenz. Additionally, she was on low-dose vitamin D3 substitution (25 μg/d) and calcium supplementation (500 mg/d) due to systemic steroid treatment.

Conclusion:

Additionally to regular control of renal function, serologic level of calcium should be supervised in patients concomitantly treated with tenofovir and colecalciferol.

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Authors and Affiliations

  1. Klinik für Pneumologie, Zentrum Innere Medizin, Medizinische Hochschule Hannover, Hannover, Germany

    Mahyar Lavae-Mokhtari

  2. Klinik für Immunologie und Rheumatologie, Zentrum Innere Medizin, Medizinische Hochschule Hannover, Hannover, Germany

    Somayeh Mohammad-Khani, Reinhold Ernst Schmidt & Matthias Stoll

  3. Klinik für Pneumologie, Zentrum Innere Medizin, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Germany

    Mahyar Lavae-Mokhtari

Authors
  1. Mahyar Lavae-Mokhtari
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  2. Somayeh Mohammad-Khani
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  3. Reinhold Ernst Schmidt
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  4. Matthias Stoll
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Correspondence to Mahyar Lavae-Mokhtari.

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Lavae-Mokhtari, M., Mohammad-Khani, S., Schmidt, R.E. et al. Akutes Nierenversagen und Hyperkalzämie unter tenofovirhaltiger antiretroviraler Therapie bei einer Patientin mit AIDS und Immunrekonstitutionssyndrom nach niedrigdosierter Vitamin-D-Substitution. Med Klin 104, 810–813 (2009). https://doi.org/10.1007/s00063-009-1167-7

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