Tenofovir (truvada) and kidney disease - prevention

Question

I'm a 31 male and had seroconversion illness about a year ago. I started meds, Isentress (2 tablets/d) + Truvada (1 tablet/d), a week ago (lab data: VL was 360000, cd4 510; no diabetes etc). No significant side effects, except for muscle pain due to lactic acidosis production the first two days. My concern is about my kidneys. I was reading that there have been case reports of kidney damage caused by tenofovir (in Truvada). Also, asymptomatic renal tubule damage may affect people taking tenofovir even if they have a normal glomerular filtration rate. What I am asking is: first, how to proceed in getting more precise measure of kidney toxicity? Second, is it possible to clean renal tubules (either mechanically or pharmacologically). Third, does taking vitamin d supplements make more damage to my kidneys? Please advice me. Thank you in advance. Alex

Answer

The rate of clinically significant kidney damage is low for most patients but merits monitoring. Idiopathic (unpredicted) damage can occur so monitoring has to be continued on a regular basis. Risk is higher if preexisting kidney damage or risk for kidney problems (including hypertension, protein in urine, diabetes, hepatitis C). Monitoring kidney function using creatinine clearance calculations is recommended when taking tenofovir. If concerned about Fanconi syndrome then checking serum phosphate, glucose, and potassium levels and urine glucose levels is recommended. I am not aware of any way to actually cleanse renal tubules though avoiding regular use of drugs that can cause kidney problems (such as non-steroidal anti-inflammatory agents-NSAIDs-like ibuprofen) is one key factor. KH