Effect of nucleoside/nucleotide analogues on kidney function in patient with chronic hepatitis B

Abstract

Nucleoside/nucleotide analogues (NAs) which used to treat chronic hepatitis B and had been in the domestic market include adefovir dipivoxil (ADV), tenofovir (TDF), lamivudine ( LAM), telbivudine (LDT) and entecavir (ETV). ADV and TDF have nephrotoxicity , LAM and ETV have a lesser effects on kidney function , and LDT has certain effect of improving kidney function. The diagnostic criteria of kidney injury due to NAs are serum creatinine (Scr) level higher than that of the baseline value (>44.2 μmol/L) or serum phosphorus level lower than that of the baseline value (<0.5 mmol/L) on two successive detections. The incidence rate of kidney injury due to ADV was higher than that due to TDF. The clinical manifestation of kidney injury due to ADV and TDF was Fanconi syndrome. The patient develops local or systemic osteodynia, osteoporosis, and amyasthenia, even limitation of activity and halisteresis in serious cases. The laboratory tests show increase in Scr, decrease in serum phosphorus and uric acid. The mechanisms of nephrotoxicity of ADV and TDF are related to injury of renal tubular epithelial cell mitochondria, change of renal tubular transport protein, and accumulation of drugs in proximal convoluted tubule. The nephrotoxicity of NAs are related to dosage, patients' age, body weight, baseline level of estimated glomerular filtration rate (eGFR), primary disease, genetic factor, diet and drug. The patient who takes ADV or TDF for long term should monitor SCr, serum phosphorus, eGFR, uric acid, microalbuminuria, and glucose in urine regularly. ADV or TDF should be stopped timely in the case of appearance of symptom of kidney injury. The medication should be changed to LDT or ETV. Phosphorus compounds, vitamin D and calcium should be given. Key words: Hepatitis B, chronic; Nucleosides; Renal insufficiency