Hypotonic fluids should not be used in volume-depleted children.

To the Editor: We read with interest the excellent article of Daugas et al [1] on HAART-related nephropathies and we would like to clarify several points. There has been no case report of Fanconi syndrome (FS) related to reverse transcriptase inhibitors (RTIs) except one induced by didanosine [2]. Actually, the suspected case of nevirapine-induced FS was largely related to lactic acidosis rather than renal tubular acidosis, considering the anion gap that was increased [3]. It is speculative to incriminate enfuvirtide as a potential cause of membranoproliferative glomerulonephritis (MPGN). Indeed, the diagnosis of MPGN was made on a renal biopsy performed after 57 days of enfuvirtide therapy together with tenofovir, lamivudine, lopinavirritonavir, amprenavir, and efavirenz, and in a patient with a history of diabetes and seasonal allergies. Furthermore, in this patient, renal abnormalities (proteinuria and hematuria) were already present before enfuvirtide was started [4]. Finally, the entire chapter on nucleotide reverse transcriptase inhibitors (NtRTIs) is confusing with regard to adefovir potential renal toxicity. Effectively, it is crucial to specify that at its normal dosage of 10 mg daily for the treatment of (hepatitis B virus) HBV infection, adefovir is not nephrotoxic [5]. Furthermore, cidofovir at 3 mg/kg for BK virus infection has also been reported not to be nephrotoxic [6].