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Fanconi syndrome

Fanconi syndrome is a defect of proximal tubule leading to malabsorption of various electrolytes and substances that are usually absorbed by the proximal tubule. It could be an inherited or acquired condition Fanconi syndrome or Fanconi's syndrome (English: / fɑːnˈkoʊni /, / fæn -/) is a syndrome of inadequate reabsorption in the proximal renal tubules of the kidney. The syndrome can be caused by various underlying congenital or acquired diseases, by toxicity (for example, from toxic heavy metals), or by adverse drug reactions Fanconi syndrome is a disorder of the kidney tubes in which certain substances normally absorbed into the bloodstream by the kidneys are released into the urine instead

Fanconi syndrome is a rare disorder of kidney tubule function that results in excess amounts of glucose, bicarbonate, phosphates (phosphorus salts), uric acid, potassium, and certain amino acids being excreted in the urine. (See also Introduction to Disorders of Kidney Tubules. Fanconi syndrome, also known as the DeToni, Debré, Fanconi syndrome is a global dysfunction of the proximal tubule characterized by glucosuria, phosphaturia, generalized aminoaciduria, and type II renal tubular acidosis. Often there is hypokalemia, sodium wasting, and dehydration. In children, it ty Fanconi syndrome is a disorder with the proximal tubules of the kidney. It causes important nutrients to be excreted by the body rather than reabsorbed into the bloodstream, so those with Fanconi. Fanconi Syndrome. Fanconi's syndrome is the result of a generalized proximal tubular defect, which can result from genetic causes such as Wilson's disease and galactosemia, or acquired damage from heavy metals, connective tissue disorders, hematological malignancies (Clarke et al., 1995) or medications (Colson and De Broe, 2005

Fanconi Syndrome - StatPearls - NCBI Bookshel

Fanconi Syndrome, or Fanconi's Syndrome, is a rare disorder which affects the proximal tubules of the kidney and does not allow the re-absorption of essential minerals and glucose into blood. Rather, such important nutrients get wasted through urine. After the fluid is filtered, the tubule is supposed to process it but it fails to do that A number of therapeutic drugs are toxic to the kidney proximal tubule (PT) and can cause the renal Fanconi syndrome (FS). The most frequently implicated drugs are cisplatin, ifosfamide, tenofovir, sodium valproate and aminoglycoside antibiotics, and the new oral iron chelator deferasirox has also recently been associated with FS Fanconi syndrome is a disease that is associated with dysfunction of the proximal tubule of the kidney Fanconi anemia (FA) is a rare genetic disorder, in the category of inherited bone marrow failure syndromes. Half the patients are diagnosed prior to age 10, while about 10% are diagnosed as adults. Early diagnoses are facilitated in patients with birth defects, such as small size, abnormal thumbs and/or radial bones, skin pigmentation, small. Fanconi Bickel syndrome (FBS) is a rare condition characterized by the accumulation of a substance called glycogen in different parts of the body. Glycogen is created when the body needs to store glucose (sugar). When the body needs sugar again, glycogen is transformed back into glucose for use

Fanconi syndrome - Wikipedi

  1. o acids, glucose, phosphate, bicarbonate) in the absence of high plasma..
  2. Fanconi anemia is a rare and serious inherited blood disorder that leads to bone marrow failure. It prevents bone marrow from making enough new blood cells for the body to work properly. Fanconi anemia can also cause bone marrow to make faulty blood cells. This can lead to serious health problems such as leukemia, a type of blood cancer
  3. Fanconi syndrome is an inherited disorder in which the proximal renal tubules of the kidney do not properly reabsorb electrolytes and nutrients back into the body, but instead spill them into the urine. Symptoms include excessive drinking (polydipsia), excessive urination (polyuria), and glucose in the urine (glucosuria.
  4. o acids, and other nutrients into the bloodstream when blood passes through the kidneys. Acquired Fanconi syndrome may be caused by use of certain antiretroviral (ARV) drugs

Fanconi syndrome: MedlinePlus Medical Encyclopedi

Fanconi syndrome refers to abnormal function of a part of the kidneys called the tubules. The tubules should reabsorb water, electrolytes and nutrients that would otherwise be excreted in the urine, but that are critical to normal metabolic function Fanconi syndrome consists of multiple defects in renal proximal tubular reabsorption, causing glucosuria, phosphaturia, generalized aminoaciduria, and bicarbonate wasting. It may be hereditary or acquired. Symptoms in children are failure to thrive, growth retardation, and rickets. Symptoms in adults are osteomalacia and muscle weakness Fanconi-Albertini-Zellweger syndrome - syndrome characterized by multiple conditions including congenital heart defect, microdontia, metabolic acidosis, and bone-related problems as well as growth retardation

A Fanconi syndrome ensues only in those forms of the syndrome in which the deposition of glycogen in the renal tubules interferes with the generation of ATP. The typical example is Fanconi-Bickel syndrome, characterized by impaired galactose use and the deposition of glycogen in liver and proximal tubule cells Fanconi Syndrome Fanconi syndrome is a generalized proximal tubular reabsorptive defect resulting in excessive loss of many solutes in the urine. It has been reported as an acquired condition in dogs (chicken jerky treat ingestion, gentamicin nephrotoxicosis, and an idiopathic form) and in a heritable form in a variety of breeds (most notably.

Fanconi Syndrome - Kidney and Urinary Tract Disorders

  1. gly unrelated disorders. Kidney malfunction leads to excessive urine production and excessive thirst, resulting in deficits of water, calcium, potassium, magnesium, and other substances in the body. It often leads to bone.
  2. o acids, uric acid, and bicarbonates instead of being reabsorbed in the body pass on to the urine. Fanconi Syndrome usually affects proximal tubule. The proximal tubule is the part of tubule which processes fluids after it is.
  3. Renal Fanconi syndrome refers to the generalised dysfunction of the proximal tubule. In its isolated form, renal Fanconi syndrome only affects the proximal tubule and not the other nephron segments

Fanconi Syndrome - PubMe

  1. ant renal disorder resulting from decreased solute and water reabsorption in the proximal tubule of the kidney. Patients have polydipsia and polyuria with phosphaturia, glycosuria, and a
  2. Fanconi syndrome is a condition that affects the proximal renal tubule in the kidney and impairs the organ's ability to reabsorb substances before they are excreted in the urine. The proximal..
  3. Fanconi syndrome can be primary, secondary or idiopathic; the result of proximal renal tubular dysfunction, in this condition the kidneys won't reabsorb electrolytes and nutrients into the body as expected, instead releasing them into the dog's urine
  4. o acid, phosphate, urate, and bicarbonate reabsorption. It is classified as a type 2 renal tubular acidosis. Fanconi syndrome may occur in either inherited or acquired forms. Inherited forms mainly present in childhood and may be due to genetic diseases including galactosemia, Wilson disease.

Fanconi Syndrome: Symptoms, Causes, Treatment, and Outloo

Fanconi Syndrome in the Sudanese medical literature. The Case: A.H.K., is a nine months old boy from the west of the Sudan. He was the product of the sixth pregnancy, the first of which terminated in still birth. Two of his sisters died at the age of 2-3 years of acute gastroenteritis withou Fanconi Syndrome is a very broad characterization that simply refers to a generalized resorptive defect in the proximal convoluted tubule of the kidney. Causes: causes include hereditary defects (such as: Wilson disease, tyrosinemia, glycogen storage disease), ischemia, multiple myeloma, nephrotoxins/drugs (e.g., expired tetracyclines. Description of Fanconi Syndrome and its Control. In this condition, the renal tubules of the kidney begin to fail to do their proper job of resorbing nutrients into the dog's system. Without testing and subsequent oral supplementation, the dog's internal organs begin to falter, the dog looses condition, and will ultimately die

What is Fanconi syndrome. Fanconi syndrome is a rare disorder of the kidney tubule function that results in excess amounts of glucose, bicarbonate, phosphates (phosphorus salts), uric acid, potassium, and certain amino acids being excreted in the urine 1).. Fanconi syndrome is unrelated to and should not be confused with Fanconi anemia [ 1 ] Fanconi's syndrome may be inherited or acquired and leads to aminoaciduria, glycosuria, phosphaturia, renal tubular acidosis (RTA) type 2 (proximal), hypophosphataemic rickets (children) or osteomalacia (adults), and renal glycosuria Medical definition of Fanconi syndrome: a disorder of reabsorption in the proximal convoluted tubules of the kidney characterized especially by the presence of glucose, amino acids, and phosphates in the urine The kidney disease leads to a Fanconi syndrome type pattern of kidney failure. Pancreatic insufficiency, ovarian failure, myopathy, and central nervous system signs are often seen. Patients require renal transplantation, often in the first decade of life. Slow eating and dysphagia are common. Heterozygotes may have elevated levels of free.

1 Fanconi Renal Disease Management Protocol for Veterinarians By Steve Gonto, M.M.Sc., Ph.D. Revised February 29, 2016 Definition: Renal Fanconi Disease is a unique disorder distinct and unrelated to Fanconi Anemia.Renal Fanconi is a reabsorption failure in the nephrons, causing bicarbonate, proteins and amino acids, as wel Acquired Fanconi syndrome is the generalized dysfunction of the proximal tubule of the kidney caused by toxic exposure to certain drugs and heavy metals as well as monoclonal gammopathy. This disorder can occur in children and adults and is dependent on toxin exposure history. Common drugs that cause acquired Fanconi syndrome include. Fanconi syndrome has already been established as a well-known complication of tenofovir disoproxil fumarate (TDF) therapy, but this case study is the first recorded case of Fanconi syndrome from TAF alone. The case involved a 54-year-old man with HIV seeking to establish an ongoing source of care with the researchers Fanconi syndrome is an absorption problem in the tubules that make up the kidney. In a normally functioning kidney the small tubules reabsorb minerals, blood sugar, amino acids, and water to keep the body in a metabolic balance that leads to normal functioning of all body systems Fanconi syndrome is a disorder in which the proximal renal tubules of the kidney do not properly reabsorb electrolytes and nutrients into the body, but spill them instead into the urine. Symptoms include excessive drinking (polydipsia), excessive urination (polyuria), and glucose in the urine (glucosuria). Untreated Fanconi syndrome results.

Fanconi Syndrome - an overview ScienceDirect Topic

Intraretinal Crystals in Nephopathic Cystinosis and

Fanconi Syndrome - Causes, Symptoms, Treatment and Prognosi

Fanconi syndrome represents a major proximal renal tubular defect, which hampers the adequate reabsorption of glucose, amino acids, bicarbonate, sodium, calcium, phosphate, lactate, ketones and carnitine. This rather general loss of multiple functions of the proximal renal tubules can be associated with renal tubular acidosis and lead to.

The clinical findings of (renal) Fanconi syndrome are that of polyuria, polydipsia, failure to thrive and risk of dehydration in infancy and/or early child hood. At the age of weight bearing, it. A syndrome of nausea, vomiting, proteinuria, acidosis, glycosuria, and aminoaciduria was observed in three patients. The clinical picture at first resembled that of diabetes mellitus. The three patients, a 54-yr-old woman, a 13-yr-old girl, and a 13-yr-old boy, were found to have taken deteriorated.. Ontology: Fanconi Syndrome (C0015624) Definition (NCI) A genetic or acquired disorder characterized by impairment of the function of the proximal tubules of the kidney. It results in decreased reabsorption of electrolytes, glucose, amino acids, and other nutrients. Definition (MSH Anna Alyse Photography. Rue developed Fanconi-like syndrome last fall. In a spate of cases that began more than a decade ago, the renal disorder was linked to consumption of certain pet treats. While reports have declined in recent years, cases are still occurring. Rue recovered after she stopped eating suspect treats and received medical care

Diamond Blackfan and Fanconi Anemia Mnemonic | USMLE STEP

Type 2 can be further classified into isolated proximal tubular bicarbonate wasting and generalized proximal tubular wasting, known as Fanconi syndrome. X-linked hypophosphatemic rickets, the most common form of hereditary hypophosphatemic rickets, is caused by phosphate wasting and manifests with hypophosphatemia and symptoms of rickets Fanconi syndrome (FS) is a generalized dysfunction of the renal proximal tubules leading to excessive urinary wasting of amino acids, glucose, phosphate, uric acid, bicarbonate, and other solutes. The patients develop failure to thrive, polyuria, polydipsia, dehydration, and rickets in children, and osteoporosis and osteomalacia in adults Fanconi syndrome is a progressive condition that can affect the kidneys of both dogs and cats. However, it's more likely to appear in dogs. Fanconi syndrome occurs when the renal tubules of the kidney are unable to properly absorb electrolytes and nutrients (sodium, potassium, glucose, phosphate, bicarbonate, and amino acids) back into the body

Video: Drug-induced renal Fanconi syndrome QJM: An

Fanconi Syndrome: Description, Causes and Risk Factors: Fanconi syndrome is a disorder in which the proximal tubular function of the kidney is impaired, resulting in decreased reabsorption of electrolytes and nutrients back into the bloodstream. Compounds involved include glucose, amino acids, uric acid, phosphate and bicarbonate.The reduced. Very little is known about the possible causes for non-genetically related (acquired) Fanconi Syndrome cases in dogs, but certain toxins, medications and infections have been linked to its.

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Fanconi Syndrome - U

Clinical course of cystinosis. Renal Fanconi syndrome is the most common initial clinical manifestation of infantile cystinosis, typically becoming evident at 6-18 months of age 28,29.Although. Synonyms for Fanconi syndrome in Free Thesaurus. Antonyms for Fanconi syndrome. 2 synonyms for congenital pancytopenia: Fanconi's anaemia, Fanconi's anemia. What are synonyms for Fanconi syndrome Fanconi anemia is an inherited disease caused by mutations in certain genes, known as FA genes. These genes provide instructions to help the body repair certain types of DNA damage. The cells of healthy people often repair DNA damage, but cells affected by Fanconi anemia cannot make these repairs

the adult Fanconi syndrome, i.e. osteomalacia, amino-aciduria,.hyposphataemia, glycosuria, pro-teinuria, systemic acidosis and hypokalaemia. In 1957 Wallis and Engle reviewed 18 patients with the adult Fanconi syndrome. In 1961 Ben-Ishay, Dreyfuss and Ullmann described a further case whose relatives had subclinical forms of the dis Fanconi syndrome consists of multiple defects in renal proximal tubular reabsorption, causing glucosuria, phosphaturia, generalized aminoaciduria, and bicarbonate wasting.It may be hereditary or acquired. Symptoms in children are failure to thrive, growth retardation, and rickets Fanconi syndrome, there is a marked generalized increase in the urinary excretion of amino acids. Clinical un'estigations. The degree and pattern of this hyper-aminoacidunia in the Fanconi syndrome varies from disease to disease and even from patient to patient with a particular disease associated with the Fanconi syndrome. Brodehl foun

Renal Fanconi syndrome (RFS) refers to the generalized dysfunction of the proximal tubule (PT) (Kleta R. Fanconi or not Fanconi? Lowe syndrome revisited. Clin J Am Soc Nephrol 2008; 3: 1244-1245). In its isolated form, RFS only affects the PT, but not the other nephron segments Fanconi syndrome is a rare disorder affecting the functioning of the kidneys. Specifically, the disorder negative impacts the kidney tubules and causes excessive amounts of glucose, phosphate, uric acid, bicarbonate, potassium, and some amino acids to be excreted in the urine

Fanconi syndrome can be primary (inherited) or secondary (acquired). The most common cause of Fanconi syndrome with proximal RTA in adults is the acquired form, which is the consequence of toxic or immunologic factors that impair proximal tubule function. Examples include amyloidosis, multiple myeloma, drugs, and heavy metals such as lead. Fanconi syndrome is a renal proximal tubule defect that causes reabsorption defects of electrolytes. The clinical features of Fanconi syndrome are amino aciduria, proteinuria, hypophosphatemia, metabolic acidosis, and glycosuria. In children, it is usually resulting from a genetic defect, such as cystinosis, galactosemia, tyrosinemia, hereditary fructose intolerance, and Wilson disease [1]

Fanconi Anemia - NORD (National Organization for Rare

Fanconi syndrome is caused by generalized proximal tubular dysfunction and manifested by phosphaturia, renal glucosuria, aminoaciduria, tubular proteinuria, and proxima Fanconi syndrome is characterized by a generalized dysfunction of the renal proximal tubule that results in the urinary loss of substances normally reabsorbed by the kidney at this site. The substrates lost include bicarbonate, glucose, amino acids, phosphate, small proteins and peptides, and organic acids and bases Fanconi Anemia: Guidelines for Diagnosis and Management, Fourth Edition, is the result of a Consensus Conference held by the Fanconi Anemia Research Fund in Herndon, Va., April 5-6, 2013. It replaces earlier editions published in 1999, 2003, and 2008. These guidelines are published for physicians wh Fanconi syndrome is a disorder of the kidney tubes in which certain substances normally absorbed into the bloodstream by the kidneys are released into the urine instead. Alternative Names De Toni-Fanconi-Debré syndrome Causes Fanconi syndrome can be caused by faulty genes, or it may result later in life due to kidney damage

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Fanconi Bickel syndrome Genetic and Rare Diseases

Fanconi Anemia Mutation Database. The Fanconi Anemia Mutation Database was established in 1998 as a cooperative effort to accelerate the availability of information on mutations in these important cancer-predisposing genes. Although Fanconi anemia is a rare disorder with recessive inheritance, Fanconi anemia genes have been shown to play an. Fanconi syndrome could arise because of a defect in one of six areas as shown. ATP, Adenosine triphosphate. Fanconi Syndrome Definition. In the 1930s, de Toni, Debré, and coworkers and Fanconi independently described several children with the combination of renal rickets, glycosuria, and hypophosphatemia. Fanconi syndrome now refers to a.

Differential diagnosis of myelodysplastic syndrome: anemia

Fanconi Syndrome Workup: Laboratory Studies, Imaging

Fanconi syndrome is a complex renal disorder that may be acquired or inherited. The fundamental problem in this syndrome is the damage to the proximal renal tubule which leads to both renal and external manifestations. Fanconi Renotubular Syndrome (Fanconi's Syndrome): Read more about Symptoms, Diagnosis, Treatment, Complications, Causes and Prognosis Fanconi renotubular syndrome-5 (FRTS5) is a mitochondrial disorder characterized by proximal renotubular dysfunction from birth, followed by progressive kidney disease and pulmonary fibrosis. It occurs only in individuals of Acadian descent (Crocker et al., 1997 and Hartmannova et al., 2016). For a discussion of genetic heterogeneity of Fanconi. Fanconi anemia is different from Fanconi syndrome, a rare kidney disorder. What Causes Fanconi Anemia? Fanconi anemia is an inherited disease caused by changes (mutations) in certain genes, known as FA genes. Experts have found 23 different FA genes. The disease occurs when there is a change (mutation) in one of these 23 genes Fanconi Syndrome. 7; Learn 23% faster with PEAK Account. PEAK. Lucy Liu Feed. Bullets. 0 % 0. 0. 0. Questions. N/A. N/A. 0. 0. 2. 0 % Topic. Review Topic. 0. 0. N/A. N/A. Questions. 2. 0. 0. Snapshot: A 10-year-old girl with a past medical history of epilepsy presents to the emergency room after sustaining a fall on the playground. She was.

Fanconi Anemia - St

Fanconi Bickel syndrome (FBS) is a rare condition characterized by the accumulation of a substance called glycogen in different parts of the body. Glycogen is created when the body needs to store glucose (sugar). When the body needs sugar again, glycogen is transformed back into glucose for use. [13118] People with Fanconi Bickel syndrome do. Adult (greater than or equal to 18 years) HIV-1 infected subjects regardless of race or ethnicity. Subjects must be on a stable ARV regimen for greater than or equal to 1 month prior to study entry. Evidence of protocol-defined Fanconi syndrome. TDF subjects must be on TDF-containing regimen at the time of onset of Fanconi syndrome De Toni-Fanconi syndrome, a metabolic disorder affecting kidney transport, characterized by the failure of the kidney tubules to reabsorb water, phosphate, potassium, glucose, amino acids, and other substances.When the disorder is accompanied by cystinosis (q.v.), a deposition of cystine crystals, it is called Fanconi's syndrome; there is some variation, however, in the designation of. Fanconi syndrome may be inherited or acquired from other causes. The most common form of Fanconi syndrome is an inherited dis-order in the Basenji dog. A recent increase in the number of cases of acquired Fanconi syndrome in non-Basenji dogs is potentially linked to ingestion (eating) of chicken jerky treats, but this associ Find details on Kidney: Fanconi and Fanconi-like syndromes in dogs including diagnosis and symptoms, pathogenesis, prevention, treatment, prognosis and more. All information is peer reviewed

Fanconi Syndrome Orthopedic Foundation for Animals

Fanconi Anemia and Fanconi Syndrome: Time to Correct the Misnomers. Maher, Ossama M. MD; Moonat, Hatel R. DO. Author Information . Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX. The authors declare no conflict of interest Fanconi syndrome, which is characterized by a defect in proximal tubular reabsorption of glucose, amino acids, uric acid, phosphate, and HCO3 -, can occur due to inherited or acquired causes. Primary inherited Fanconi syndrome is caused by a mutation in the sodium-phosphate cotransporter (NaPi-II) in the proximal tubule.. Fanconi's syndrome is characterized by pancytopenia and multiple congenital anomalies. Cardiovascular abnormalities, however, have not been frequently associated. This is believed to be the first reported instance of pulmonary arteriovenous fistulae and Fanconi's syndrome. In 1927 Fanconi described a fatal disorder in three brothers. Fanconi's syndrome is characterized by renal glycosuria, phosphaturia, aminoaciduria, and acidosis with or without proteinuria and rickets. It is associated with the ingestion of outdated or degraded tetracycline. Additionally,.

Genetic Syndrome Pictures - StudyBlue

Fanconi Syndrome NIH - Clinicalinf

Fanconi syndrome is a metabolic disorder, which was first described by Lignac in 1924 and later defined by Fanconi in 1936 [1-3]. It is characterized by dysfunction of the proximal renal tubules, leading to impaired proximal tubular reabsorption of amino acids, glucose, phosphate, urate, and bicarbonate Fanconi syndrome is when the kidneys do not reabsorb molecules in the filtrate. The substances that are not reabsorbed are glucose, amino acids, small proteins, water, and ions. This kidney malfunction causes increased urine production which causes increased thirst, decreased amount of water in the body, and decreased amounts of calcium. The latter has been associated with hypophosphatemia, hypokalemia, hypouricemia, and metabolic acidosis, mimicking Fanconi syndrome [8, 9], which represents impaired reabsorption in the proximal tubule of the nephron, resulting in loss of bicarbonate, glucose, phosphate, uric acid, and amino acids . We report herein a case of acute kidney. Fanconi syndrome can also be one of many manifestations of various inherited systemic diseases, such as cystinosis. Many of the acquired causes of Fanconi syndrome with or without proximal RTA are drug-induced, with the list of causative agents increasing as newer drugs are introduced for clinical use, mainly in the oncology field Fanconi Syndrome in Dogs. Fanconi syndrome is a collection of abnormalities arising from the defective transport of water, sodium, potassium, glucose, phosphate, bicarbonate, and amino acids from the kidneys; impaired tubular reabsorption, the process by which solutes and water are removed from the tubular fluid and transported into the blood, causes excessive urinary excretion of these solutes

Fanconi Syndrome in Dogs VCA Animal Hospita

Renal Fanconi's syndrome comprises a heterogeneous group of disorders characterized by proximal tubular dysfunction leading to generalized aminoaciduria, glucosuria, phosphaturia, low-molecular. Orotic aciduria. Adenosine deaminase deficiency. Xeroderma pigmentosum. Li-Fraumeni syndrome. Bloom syndrome. Fanconi anemia. McCune-Albright syndrome. Acute radiation syndrome. Purine and pyrimidine synthesis and metabolism disorders: Pathology Review Fanconi Syndrome. The ICD-10-CM Alphabetical Index is designed to allow medical coders to look up various medical terms and connect them with the appropriate ICD codes. There are 1 terms under the parent term 'Fanconi Syndrome' in the ICD-10-CM Alphabetical Index

Fanconi syndrome [MIM 134600] is a generalised dysfunction of the renal proximal tubule in which the genetic aetiology has been described in a variety of syndromes that include Cystinosis [MIM 219800], Lowe syndrome [MIM 309000] or Fanconi-Bickel syndrome [MIM 227810] Evaluation of Fanconi Syndrome and Cystinosis The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government Although renal Fanconi syndrome resulting from valproate (VPA) has occasionally been reported, the detailed clinical characteristics of this disease remain unclear. To clarify the clinical features of patients with VPA-induced Fanconi syndrome, we analyzed the clinical and laboratory data of seven affected patients. All patients were children, were severely disabled and required tube feeding.