Abstract
BackgroundTenofovir disoproxil fumarate (TDF) is known to reduce estimated glomerular filtration rate (eGFR). It is clinically important to identify patients at high risk for renal dysfunction as early as possible. Among the tubular markers, urinary β2 microglobulin (Uβ2MG) is a well-known biomarker of TDF-related tubulopathy. However, renal dysfunction has often been occurred in patients receiving TDF with low Uβ2MG levels. Recently, urinary liver-type fatty acid–binding protein (UL-FABP) was suggested to be predictor of the progression of renal dysfunction. Thus, we focused on UL-FABP in patients receiving TDF with low Uβ2MG levels.MethodsA retrospective, observational, single-center study, between January 2013 and December 2016, was conducted. Two renal end points (> 25% decrement in eGFR and > 20 mL/min/1.73 m2 decrement relative to the baseline) were assessed. To estimate the effect of UL-FABP on time to the first event, log-rank test was performed.ResultsA total of 24 Japanese outpatients with human immunodeficiency virus receiving TDF were enrolled. The outcome each occurred in two patients during the follow-up period. UL-FABP levels ≥4.0 μg/g creatinine was significantly associated with > 25% decrement and > 20 mL/min/1.73 m2 decrement (p = 0.006 and 0.001, respectively).ConclusionBased on our preliminary analysis, UL-FABP levels ≥4.0 μg/g creatinine predict renal dysfunction in patients receiving TDF with low Uβ2MG levels.
Highlights
Tenofovir disoproxil fumarate (TDF) is known to reduce estimated glomerular filtration rate
urinary β2 microglobulin (Uβ2MG) is a well-known biomarker of TDF-related tubulopathy, and it was demonstrated that Uβ2MG levels ≥1700 μg/L were related to renal dysfunction in patients receiving TDF [5]
There were no significant differences in the clinical characteristics between individuals with ≥ and < urinary liver-type fatty acid–binding protein (UL-FABP) levels of 4.0 μg/g creatinine
Summary
Tenofovir disoproxil fumarate (TDF) is known to reduce estimated glomerular filtration rate (eGFR). Urinary liver-type fatty acid–binding protein (UL-FABP) was suggested to be predictor of the progression of renal dysfunction. Renal dysfunction is recognized with increasing frequency among the non-infectious comorbidities associated with human immunodeficiency virus (HIV) infection. It is caused by a number of factors, and nephrotoxicity resulting from antiretroviral therapy (ART) is one of them. Urinary L-FABP (UL-FABP) level (≥ 4.0 μg/g creatinine) was a potential predictor of renal dysfunction in patients receiving ART in our previous pilot study [4]. It has not been known that UL-FABP was a risk factor for renal dysfunction regardless of whether Urinary β2 microglobulin (Uβ2MG) level was high or low. The aim of this study was to gain a better understanding of the clinical utility of UL-FABP in patients receiving TDF with low Uβ2MG levels
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