Antenatal tenofovir induced acute kidney injury in a neonate born to seropositive mother- A case report

Abstract

Acute kidney injury (AKI) is an independent risk factor for morbidity and mortality in neonates. The causes of neonatal AKI are varied and multifactorial . Broadly ,these can be divided into prerenal, renal, and postrenal pathologies and have long standing consequences .Neonates admitted to NICU have frequent nephrotoxic drug exposure postnatally, however antenatal /transplacental exposure has not been adequately studied and reported. Here we present a case of a newborn with AKI secondary to antenatal tenofovir exposure .Mother was diagnosed with HIV four years prior to conception and was on TLD(tenofovir disoproxil,lamivudine,dolutegravir) regimen . Drugs were continued throughout pregnancy with good compliance. Baby was delivered at term vaginally and was with mother for the first 48 hours. At 50 hours, mother complained that baby has not passed urine, for which renal functions were done and found to be deranged (Creatinine-2.3 BUN-29) .Baby was investigated for all probable causes of acute kidney injury (AKI) .However, all were ruled out based on history, examination and investigations . Urine routine showed eosinophiluria  and crystalluria pointing towards drug induced AKI. Baby was hemodynamically stable and breastfeeding well throughout however the renal functions continued to deteriorate (Peak creatinine-4,BUN-40 on DOL7).Baby was managed conservatively with complete resolution by DOL-10. Tenofovir is a nephrotoxic  agent and has been reported to cause various foetal side effects. Antenatal exposure to tenofovir warrants close observation and evaluation in neonates.