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Valproic-induced Fanconi syndrome: Clinical features, risk factors, diagnosis and management

OBJECTIVE: Although Fanconi syndrome (FS) induced by valproate (VPA) has occasionally been reported, the detailed clinical features of the disease remain unclear. The aim of this study was to elucidate the clinical features of patients with VPA-induced FS. METHODS: We searched Chinese and English da...

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Autores principales: Wang, Chunjiang, Zhou, Yulu, Song, Liying, Deng, Zhenzhen, Fang, Weijin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9522966/
https://www.ncbi.nlm.nih.gov/pubmed/36186816
http://dx.doi.org/10.3389/fmed.2022.945244
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author Wang, Chunjiang
Zhou, Yulu
Song, Liying
Deng, Zhenzhen
Fang, Weijin
author_facet Wang, Chunjiang
Zhou, Yulu
Song, Liying
Deng, Zhenzhen
Fang, Weijin
author_sort Wang, Chunjiang
collection PubMed
description OBJECTIVE: Although Fanconi syndrome (FS) induced by valproate (VPA) has occasionally been reported, the detailed clinical features of the disease remain unclear. The aim of this study was to elucidate the clinical features of patients with VPA-induced FS. METHODS: We searched Chinese and English databases for all original studies, clinical reports, and case reports on VPA-induced FS published before March 2022. RESULTS: A total of 29 articles including 54 patients (28 males and 24 females) were included. The patients had a median age of 7 years (range 2–34 years), had severely disabled (87.0%), tube feeding (64.8%), and received an average of 1.8 medications other than VPA. The median duration of VPA treatment was 4 years (range 0.7–15.5). Pathological fractures (25.9%), unexplained fever (11.1%), muscle weakness (9.3%), and edema (9.3%) were the most common symptoms, while 18 patients were diagnosed in incidental laboratory tests. Blood tests revealed hypokalemia (69.2%), hypophosphatemia (98.0%), and hypouricemia (93.3%). Urinalysis revealed glucosuria (96.1%), proteinuria (100.0%), generalized hyperaminoaciduria (100.0 %), β2 macroglobulin (100.0%). Decreased percent total reabsorption of phosphate (%TRP) found in 94.1% of patients, and increased fractional excretion of uric acid (FEUA) were found in 100% of patients. The median time to resolution of FS after discontinuation of drug therapy was 3 months (range 0.25–18). CONCLUSIONS: The possibility of FS needs to be considered with long-term VPA administration, especially in young, tube-fed, severely disabled patients who are co-administered with anticonvulsants. Patients receiving VPA should have regular blood and urine tests. Abnormal laboratory values returned to normal levels after VPA discontinuation.
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spelling pubmed-95229662022-10-01 Valproic-induced Fanconi syndrome: Clinical features, risk factors, diagnosis and management Wang, Chunjiang Zhou, Yulu Song, Liying Deng, Zhenzhen Fang, Weijin Front Med (Lausanne) Medicine OBJECTIVE: Although Fanconi syndrome (FS) induced by valproate (VPA) has occasionally been reported, the detailed clinical features of the disease remain unclear. The aim of this study was to elucidate the clinical features of patients with VPA-induced FS. METHODS: We searched Chinese and English databases for all original studies, clinical reports, and case reports on VPA-induced FS published before March 2022. RESULTS: A total of 29 articles including 54 patients (28 males and 24 females) were included. The patients had a median age of 7 years (range 2–34 years), had severely disabled (87.0%), tube feeding (64.8%), and received an average of 1.8 medications other than VPA. The median duration of VPA treatment was 4 years (range 0.7–15.5). Pathological fractures (25.9%), unexplained fever (11.1%), muscle weakness (9.3%), and edema (9.3%) were the most common symptoms, while 18 patients were diagnosed in incidental laboratory tests. Blood tests revealed hypokalemia (69.2%), hypophosphatemia (98.0%), and hypouricemia (93.3%). Urinalysis revealed glucosuria (96.1%), proteinuria (100.0%), generalized hyperaminoaciduria (100.0 %), β2 macroglobulin (100.0%). Decreased percent total reabsorption of phosphate (%TRP) found in 94.1% of patients, and increased fractional excretion of uric acid (FEUA) were found in 100% of patients. The median time to resolution of FS after discontinuation of drug therapy was 3 months (range 0.25–18). CONCLUSIONS: The possibility of FS needs to be considered with long-term VPA administration, especially in young, tube-fed, severely disabled patients who are co-administered with anticonvulsants. Patients receiving VPA should have regular blood and urine tests. Abnormal laboratory values returned to normal levels after VPA discontinuation. Frontiers Media S.A. 2022-09-16 /pmc/articles/PMC9522966/ /pubmed/36186816 http://dx.doi.org/10.3389/fmed.2022.945244 Text en Copyright © 2022 Wang, Zhou, Song, Deng and Fang. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Wang, Chunjiang
Zhou, Yulu
Song, Liying
Deng, Zhenzhen
Fang, Weijin
Valproic-induced Fanconi syndrome: Clinical features, risk factors, diagnosis and management
title Valproic-induced Fanconi syndrome: Clinical features, risk factors, diagnosis and management
title_full Valproic-induced Fanconi syndrome: Clinical features, risk factors, diagnosis and management
title_fullStr Valproic-induced Fanconi syndrome: Clinical features, risk factors, diagnosis and management
title_full_unstemmed Valproic-induced Fanconi syndrome: Clinical features, risk factors, diagnosis and management
title_short Valproic-induced Fanconi syndrome: Clinical features, risk factors, diagnosis and management
title_sort valproic-induced fanconi syndrome: clinical features, risk factors, diagnosis and management
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9522966/
https://www.ncbi.nlm.nih.gov/pubmed/36186816
http://dx.doi.org/10.3389/fmed.2022.945244
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