Academy Exchange

Any recommendations on further evaluation, testing and monitoring of patients on tenofovir that have a mild increase in their Cr?

I have a healthy 26 male on tenofovir/emtracitabine for PrEP who had baseline Cr of 1.16 prior to start of PrEP. Cr recently has been 1.2-1.39 on repeated testing.  No other known medical issues and taking no other drugs. Urinalysis normal. 

Appreciate input on how to proceed?

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Jarrett Sell, MD
Penn State Health /Alder Health
Harrisburg PA
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Have you excluded interference from supplements? Keen gym bunnies regularly take creatine as a workout supplement and it'll lead to falsely high Cr. I've seen this both in practice and, i'm slightly embarrassed to admit, in myself. Pre-workout mix, morning gym, lab tests, alarm bells!

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George Brooks RPh AAHIVP
Seattle WA
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Original Message:
Sent: 05-22-2020 10:47
From: Jarrett Sell
Subject: Elevated Creatinine on Tenofovir

Any recommendations on further evaluation, testing and monitoring of patients on tenofovir that have a mild increase in their Cr?

I have a healthy 26 male on tenofovir/emtracitabine for PrEP who had baseline Cr of 1.16 prior to start of PrEP. Cr recently has been 1.2-1.39 on repeated testing.  No other known medical issues and taking no other drugs. Urinalysis normal. 

Appreciate input on how to proceed?

------------------------------
Jarrett Sell, MD
Penn State Health /Alder Health
Harrisburg PA
------------------------------

TAF or TDF currently, Jarrett?  If TDF, would switch to TAF.  If the U/A showed proteinuria, I would check phosphate level and check urine phos and CR and calculate fractional excretion of phos.  What is CR clearance?  Maybe work them up for renal insufficiency as well if significant decrease in GFR.

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James Adams
Rancho Mirage CA
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Original Message:
Sent: 05-22-2020 10:47
From: Jarrett Sell
Subject: Elevated Creatinine on Tenofovir

Any recommendations on further evaluation, testing and monitoring of patients on tenofovir that have a mild increase in their Cr?

I have a healthy 26 male on tenofovir/emtracitabine for PrEP who had baseline Cr of 1.16 prior to start of PrEP. Cr recently has been 1.2-1.39 on repeated testing.  No other known medical issues and taking no other drugs. Urinalysis normal. 

Appreciate input on how to proceed?

------------------------------
Jarrett Sell, MD
Penn State Health /Alder Health
Harrisburg PA
------------------------------

Hello ,
Most of my patients resolve with just stop taking the supplemnts . And just interferon included. But it it does not work.My patient and I  will have a very serious talk and find  the other option which is Descovy. If the patient stop taking supplements is drinking water, is in Descovy and Cr still going up . I will do the whole kidney work. I pay very close attention to the filtration rate .

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Ivania Castillo-Morris
Miramar FL
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Original Message:
Sent: 05-22-2020 20:49
From: James Adams
Subject: Elevated Creatinine on Tenofovir

TAF or TDF currently, Jarrett?  If TDF, would switch to TAF.  If the U/A showed proteinuria, I would check phosphate level and check urine phos and CR and calculate fractional excretion of phos.  What is CR clearance?  Maybe work them up for renal insufficiency as well if significant decrease in GFR.

------------------------------
James Adams
Rancho Mirage CA

Original Message:
Sent: 05-22-2020 10:47
From: Jarrett Sell
Subject: Elevated Creatinine on Tenofovir

Any recommendations on further evaluation, testing and monitoring of patients on tenofovir that have a mild increase in their Cr?

I have a healthy 26 male on tenofovir/emtracitabine for PrEP who had baseline Cr of 1.16 prior to start of PrEP. Cr recently has been 1.2-1.39 on repeated testing.  No other known medical issues and taking no other drugs. Urinalysis normal. 

Appreciate input on how to proceed?

------------------------------
Jarrett Sell, MD
Penn State Health /Alder Health
Harrisburg PA
------------------------------