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Drug-induced Fanconi syndrome associated with fumaric acid esters treatment for psoriasis: a case series
BACKGROUND: Fumaric acid esters (FAEs), an oral immunomodulating treatment for psoriasis and multiple sclerosis, have been anecdotally associated with proximal renal tubular dysfunction due to a drug-induced Fanconi syndrome. Few data are available on clinical outcomes of FAE-induced Fanconi syndrom...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4720194/ https://www.ncbi.nlm.nih.gov/pubmed/26798466 http://dx.doi.org/10.1093/ckj/sfv114 |
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author | Balak, Deepak M.W. Bouwes Bavinck, Jan Nico de Vries, Aiko P.J. Hartman, Jenny Neumann, Hendrik A. Martino Zietse, Robert Thio, Hok Bing |
author_facet | Balak, Deepak M.W. Bouwes Bavinck, Jan Nico de Vries, Aiko P.J. Hartman, Jenny Neumann, Hendrik A. Martino Zietse, Robert Thio, Hok Bing |
author_sort | Balak, Deepak M.W. |
collection | PubMed |
description | BACKGROUND: Fumaric acid esters (FAEs), an oral immunomodulating treatment for psoriasis and multiple sclerosis, have been anecdotally associated with proximal renal tubular dysfunction due to a drug-induced Fanconi syndrome. Few data are available on clinical outcomes of FAE-induced Fanconi syndrome. METHODS: Descriptive case series with two cases of Fanconi syndrome associated with FAE treatment diagnosed at two Dutch university nephrology departments, three cases reported at the Dutch and German national pharmacovigilance databases and six previously reported cases. RESULTS: All 11 cases involved female patients with psoriasis. The median age at the time of onset was 38 years [interquartile range (IQR) 37–46]. Patients received long-term FAEs treatment with a median treatment duration of 60 months (IQR 28–111). Laboratory tests were typically significant for low serum levels of phosphate and uric acid, while urinalysis showed glycosuria and proteinuria. Eight (73%) patients had developed a hypophosphataemic osteomalacia and three (27%) had pathological bone fractures. All patients discontinued FAEs, while four (36%) patients were treated with supplementation of phosphate and/or vitamin D. Five (45%) patients had persisting symptoms despite FAEs discontinuation. CONCLUSIONS: FAEs treatment can cause drug-induced Fanconi syndrome, but the association has been reported infrequently. Female patients with psoriasis treated long term with FAEs seem to be particularly at risk. Physicians treating patients with FAEs should be vigilant and monitor for the potential occurrence of Fanconi syndrome. Measurement of the urinary albumin:total protein ratio is a suggested screening tool for tubular proteinuria in Fanconi syndrome. |
format | Online Article Text |
id | pubmed-4720194 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-47201942016-01-21 Drug-induced Fanconi syndrome associated with fumaric acid esters treatment for psoriasis: a case series Balak, Deepak M.W. Bouwes Bavinck, Jan Nico de Vries, Aiko P.J. Hartman, Jenny Neumann, Hendrik A. Martino Zietse, Robert Thio, Hok Bing Clin Kidney J Tubulointerstitial Disease Diagnosis BACKGROUND: Fumaric acid esters (FAEs), an oral immunomodulating treatment for psoriasis and multiple sclerosis, have been anecdotally associated with proximal renal tubular dysfunction due to a drug-induced Fanconi syndrome. Few data are available on clinical outcomes of FAE-induced Fanconi syndrome. METHODS: Descriptive case series with two cases of Fanconi syndrome associated with FAE treatment diagnosed at two Dutch university nephrology departments, three cases reported at the Dutch and German national pharmacovigilance databases and six previously reported cases. RESULTS: All 11 cases involved female patients with psoriasis. The median age at the time of onset was 38 years [interquartile range (IQR) 37–46]. Patients received long-term FAEs treatment with a median treatment duration of 60 months (IQR 28–111). Laboratory tests were typically significant for low serum levels of phosphate and uric acid, while urinalysis showed glycosuria and proteinuria. Eight (73%) patients had developed a hypophosphataemic osteomalacia and three (27%) had pathological bone fractures. All patients discontinued FAEs, while four (36%) patients were treated with supplementation of phosphate and/or vitamin D. Five (45%) patients had persisting symptoms despite FAEs discontinuation. CONCLUSIONS: FAEs treatment can cause drug-induced Fanconi syndrome, but the association has been reported infrequently. Female patients with psoriasis treated long term with FAEs seem to be particularly at risk. Physicians treating patients with FAEs should be vigilant and monitor for the potential occurrence of Fanconi syndrome. Measurement of the urinary albumin:total protein ratio is a suggested screening tool for tubular proteinuria in Fanconi syndrome. Oxford University Press 2016-02 2015-11-10 /pmc/articles/PMC4720194/ /pubmed/26798466 http://dx.doi.org/10.1093/ckj/sfv114 Text en © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Tubulointerstitial Disease Diagnosis Balak, Deepak M.W. Bouwes Bavinck, Jan Nico de Vries, Aiko P.J. Hartman, Jenny Neumann, Hendrik A. Martino Zietse, Robert Thio, Hok Bing Drug-induced Fanconi syndrome associated with fumaric acid esters treatment for psoriasis: a case series |
title | Drug-induced Fanconi syndrome associated with fumaric acid esters treatment for psoriasis: a case series |
title_full | Drug-induced Fanconi syndrome associated with fumaric acid esters treatment for psoriasis: a case series |
title_fullStr | Drug-induced Fanconi syndrome associated with fumaric acid esters treatment for psoriasis: a case series |
title_full_unstemmed | Drug-induced Fanconi syndrome associated with fumaric acid esters treatment for psoriasis: a case series |
title_short | Drug-induced Fanconi syndrome associated with fumaric acid esters treatment for psoriasis: a case series |
title_sort | drug-induced fanconi syndrome associated with fumaric acid esters treatment for psoriasis: a case series |
topic | Tubulointerstitial Disease Diagnosis |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4720194/ https://www.ncbi.nlm.nih.gov/pubmed/26798466 http://dx.doi.org/10.1093/ckj/sfv114 |
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