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2017 ; 31
(9
): 1297-1301
Nephropedia Template TP
Samuels R
; Bayerri CR
; Sayer JA
; Price DA
; Payne BAI
AIDS
2017[Jun]; 31
(9
): 1297-1301
PMID28323756
show ga
OBJECTIVE: To determine whether tenofovir disoproxil fumarate (TDF)-associated
renal tubular dysfunction is associated with evidence of mitochondrial injury in
urine. DESIGN: Single-centre cross-sectional observational study of HIV-positive
outpatients. METHODS: Biochemistry was performed on paired serum and urine
samples. Mitochondrial DNA (mtDNA) was studied by real-time PCR and long-range
PCR on cellular fractions of urine. RESULTS: In total, 48 study participants were
enrolled of whom half were TDF treated. Mean age was 43 years. 58% had estimated
glomerular filtration rate at least 90, with no differences between ART treatment
groups. Urinary phosphate wasting was common and independently associated with
TDF exposure (P?=?0.02). No study participants had low molecular weight
proteinuria. Cellular mtDNA content in urine was heavily influenced by the
cellularity of the sample. The mtDNA 'common deletion' mutation was detectable
significantly more commonly in the urine of TDF exposed study participants
compared with unexposed (13/22 TDF study participants (59%), 4/21 TDF (19%),
P?=?0.01). Common deletion levels were not associated with age, estimated
glomerular filtration rate, or urinary phosphate wasting. No mtDNA measures were
associated with current or nadir CD4 lymphocyte counts, duration of disease or
antiretroviral therapy, or historical exposure to nucleoside analogue reverse
transcriptase inhibitors with systemic mitochondrial toxicity. CONCLUSION: The
presence of mtDNA mutations in the context of TDF exposure adds weight to the
hypothesis that TDF-associated renal damage is at least in part mitochondrially
mediated. The assessment of mtDNA markers in urine may be a feasible noninvasive
investigation for TDF-treated patients.