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Acute tubulointerstitial nephritis attributable to indinavir therapy
M Jaradat1, C Phillips, M N Yum
1Departments of Medicine and Pathology, Indiana University School of Medicine, Indianapolis, IN 46202, USA. mjaradat@iupui.edu
Summary
Indinavir sulfate can cause kidney problems in HIV patients, even with asymptomatic crystalluria. Monitoring renal function is crucial, especially when crystals are present in urine.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Indinavir sulfate is an antiretroviral medication used to treat human immunodeficiency virus (HIV) infection.
- Crystalluria and nephrolithiasis are known potential side effects of indinavir therapy.
- Asymptomatic crystalluria has often been considered a benign finding.
Observation:
- Two HIV-positive patients on indinavir developed acute interstitial nephritis with foreign body giant cell reaction.
- Both patients exhibited asymptomatic crystalluria, with one showing white blood cells (WBCs) alongside crystals.
- Renal biopsies confirmed significant inflammatory responses leading to tubular injury.
Findings:
- Indinavir-associated asymptomatic crystalluria can trigger an inflammatory response.
- This inflammation can result in acute renal impairment and tubular injury.
- The presence of WBCs with crystals may indicate a heightened inflammatory reaction.
Implications:
- Asymptomatic crystalluria in patients on indinavir may not be benign.
- Close monitoring of renal function is recommended for HIV patients on indinavir, particularly those with crystalluria.
- Early detection of renal impairment due to indinavir is essential for patient management.