Crystalluria indinavir

Several reports have suggested that patients using indinavir may also develop a syndrome consisting of back or flank pain, accompanied by crystalluria, renal function abnormalities, and evidence of tubulointerstitial nephritis on renal biopsy, but without obvious renal calculus formation (15-17). 

Reversible renal insufficiency (which again could have been due to crystalluria) has been reported with indinavir (24). 

Since the basic problem in many such cases is probably crystalluria, it should be possible to treat it with rehydration, perhaps supplemented by brief interruption of therapy this has been the conclusion of a study in which the unwanted renal effects of indinavir were prominent (25). Of 74 individuals infected with HIV-1 and taking indinavir 2.4 g/day orally, 15 had indinavir-related urological adverse effects (19 episodes), most commonly dull flank pain and dysuria. Microhematuria occurred in 16 of the 19 episodes. Four patients had urinary tract distension on... 

The results of a questionnaire survey of 878 people with HIV infection treated with antiretroviral drugs confirmed the risk of arthralgias in patients taking indinavir. The authors suggested that crystal deposition in joints, analogous to the crystalluria with nephrolithiasis that indinavir and other protease inhibitors can cause, might be responsible. 

Tsao JW, Kogan SC. Images in clinical medicine. Indinavir crystalluria. N Engl J Med 1999 340(17) 1329. 

Kopp JB, MiUer KD, Mican JA, Feuerstein IM, Vaughan E, Baker C, Pannell LK, FaUoon J. Crystalluria and urinary tract abnormahties associated with indinavir. Ann Intern Med 1997 127(2) 119-25. 

Patients with indinavir crystalluria may be asymptomatic or can develop clinical symptoms such as flank pain, back pain, dysuria, urinary urgency, fever, nausea, and vomiting. Pyuria and hematuria (commonly microscopic) may also be seen [131-133, 135-137, 138]. Indinavir crystals (Figure 1) are variable in their appearance by microscopy, usually with needle-shaped, plate-like, fan-shaped, or starburst-like appearances [131,133]. Ultrasound imaging is emerging as imaging modality of choice and may be more... 

Trainor ED, Steinberg JP, Austin GW, Solomon FIM. Indinavir crystalluria identification of patients at increased risk of developing nephrotoxicity. Arch Pathol Lab Med 1998 122 256-259. 

Berns JS, Cohen RM, Silverman M, Turner J. Acute renal failure due to indinavir crystalluria and nephrolithiasis report of two cases. Am J Kid Dis 1997 30 558-560. 

Indinavir 800 mg q. 8 hr 10% No data 100% No data 100% No data 100% Adverse effects nephrolithiasis and acute renal failure due to crystalluria or tubulointerstitial nephritis NC No data dose for GFR <10 ml/min No data... 

Patients with indinavir crystalluria may be asymptomatic or develop clinical features of renal colic, flank or back pain, dysuria, urinary urgency, fever, nausea and vomiting. Pyuria and microscopic or, less corn-... 

A unique and common adverse effect of indinavir is crystalluria and nephrolithiasis. This stems from the poor solubility of the drug, which is lower at pH 7.4 than at pH 3.5. Precipitation of indinavir and its metabolites in urine can cause renal colic, and nephrolithiasis occurs in... 

Acyclovir is eliminated in the urine by glomerular filtration and by active tubular secretion, which is inhibited by probenecid. Nephrotoxic effects, including hematuria and crystalluria, are enhanced in patients who are dehydrated or who have preexisting renal dysfunction. Adequate hydration is equally important in the case of indinavir, since it causes nephrolithiasis. However, more than 80% of a dose of indinavir is eliminated via hepatic metabolism. The answer is (A). 

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