Case presentation

A 48-year-old male presented with nausea, vomiting, diarrhea and dizziness.

History

The patient suffered from human immunodeficiency virus for which he was taking antiretroviral agents. Moreover, he had a solitary kidney. He underwent radiation, chemotherapy, and ultimately, a unilateral nephrectomy for Wilms tumor approximately 22 years ago.

Investigations

• Serum creatinine: 1.36 mg/dL
• Estimated creatinine clearance: 68.7 mL/min (based on actual body weight of 71.8 kg)
• Estimated glomerular filtration rate: 72.8 mL/min/1.73 m2
• CD4 cell count: 118 cells/mm3
• HIV viral load was undetectable

Diagnosis

Gastrointestinal side effects with antiretroviral agents used for treating human immunodeficiency virus.

Management

The patient was switched to efavirenz 600 mg /emtricitabine 200 mg /tenofovir disoproxil fumarate 300 mg once daily. Various parameters few months after the treatment were serum creatinine: 1.41 mg/dL, estimated creatinine clearance: 65.2 mL/min (body weight: 73.2 kg), estimated glomerular filtration rate: 68.2 mL/min/1.73 m2, with a CD4 cell count of 120 cells/mm3. The HIV viral load was undetectable. No evidence of nephrotoxicity was reported over a course of 19 months. Moreover, renal function was adequately maintained. Treatment with tenofovir disoproxil fumurate-based regimen appeared to be a viable option for this patient with a solitary kidney and human immunodeficiency virus.