Increased serum Phosphorus

[Mars86]

I'm a CHB, on  etv and tdf combo since for 18 months , this is the first time to have an increase in serum phosphurs about 7.7 mg/dl (Normal 2.3 to 4.7) as well decreased eGFR about 70 ..

I am 27 years old ..

your suggestions ?

[stef2011]

the interesting is that adding telbivudine even adefovir or truvada which are very toxic for kidneys recover kidneys function and drugs become non toxic

if you dont recover by fibroguard and baking soda you may consider changing entecavir with telbivudine, the potency of this combo is higher than entecavir and barrier to resistance as good as with entecavir

[djxpress]

tdf can actually cause low phosphorus levels - hypophosphatemia

[stef2011]

http://apasl.meetingxpert.net/APASL_796/poster_64119/program.aspx

tdf+telbivudine combo can be interesting too in case of kidneys problems

[Mars86]

thx stef , actually I didn't test creatinine before , always I tested eGFR and serum phosphors , I'll try to test as you mentioned ..

Thx again

[stef2011]

very difficult to say if you have kidneys damage, there are no test with sensibility high enough.study for hope posted some tests not easy to find commercially with good sensibility but don t remember all of them.

creat clearance by 24hrs urine collection as a minimum to know if you have a decline in function

also what is your blood creatinine before starting nucs and kinects under nucs

did you test creatinine microalbumine ratio?this is the test studyforhope suggested to predict damage, it gets abnormal before damage is done

[Mars86]

thx stef , ok with my above results do I have kidney damage ? can this be regressed ?

[stef2011]

sorry i have no idea but i do know that only creatinine clearance by 24hrs urine collection is realiable, formulas from blood creatinine values are useless because you can have kidneys damage and normal creatinine

i monitor my kidneys by:
creatinine clearance by 24hrs urine collection once a year
blood creratinine every 3 months
blood  Phosphorus every 3 months
blood calcium every 3 months

checked creatinine/microalbumine ratio once in 3 years

i prevent damage by fibroguard and keeping urine ph around 7 and when lowers to 6 or 6.5 i increase by baking soda

[Mars86]

thx stef , but what do you think about this increase ? why this inctreased in only one month ? as well in one month egfr decreased fro 120 to 70 ??

[stef2011]

recheck after 4 weeks all these tests if improved

my experience is my creatinine went from 1.2 to 0.7-0.8, creatinine clearance from about 108 to about 120

[stef2011]

start use of fibroguard

check that vitd is above 50ng/ml if not start supplementation of d3 and k2

as to egfr tests use creatinine clearance by 24hrs urine collection, the other tests that use formulas are not so reliable.also albumine/microalbumine ratio can be a useful test