Adefovir-induced Fanconi syndrome: diagnostic pearls and perils of late or missed diagnosis

• DOI: 10.1007/s13730-014-0114-5
• Publication Date: 2014-03-13T18:23:22Z
• Authors: Samuel Shang Ming...; Timothy Peng Lim ...; Cherng Jye Seow; Melvin Khee Shing...
• Keywords: 03 medical and health sciences; 0302 clinical medicine; 3. Good health

Low-dose adefovir therapy has been increasingly recognised as a cause of Fanconi syndrome. Being relatively novel, early diagnosis is both fraught with difficulty and yet of paramount importance given its far-reaching consequences, many of which are amenable to treatment. We discuss a patient who presented with hypokalemia and other electrolyte abnormalities suggestive of Fanconi syndrome whilst on adefovir for hepatitis B. A trans-tubular potassium gradient (TTKG = 9.4) and urinary fractional phosphate excretion (39.4 %) consistent with renal potassium and phosphate wasting together with euglycemic glycosuria, aminoaciduria and hypophosphatemic osteomalacia supported the diagnosis of adefovir-induced Fanconi syndrome. With the cessation of the culprit drug, the patient has achieved partial recovery after 9 months. A high index of suspicion coupled with regular symptom surveillance and electrolyte monitoring is recommended in the course of adefovir therapy.