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Symptomatic crystalluria associated with indinavir.

G Famularo1, S Di Toro, S Moretti

  • 1Department of Emergency Medicine, San Camillo Hospital, Rome, Italy. gfamularo@relay.uni.net

The Annals of Pharmacotherapy
|January 6, 2001
PubMed
Summary
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Indinavir can cause severe crystalluria, leading to urinary tract complications. Increased fluid intake and regular monitoring are crucial for patients taking indinavir to prevent kidney issues.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Pharmacology

Background:

  • Indinavir, a protease inhibitor, is used in HIV treatment.
  • Crystalluria is a known adverse effect of indinavir therapy.
  • Urinary tract complications can arise from indinavir-induced crystalluria.

Observation:

  • A case of a 26-year-old HIV-positive woman experiencing recurrent severe crystalluria and flank pain while on indinavir therapy.
  • Indinavir crystalluria was confirmed, leading to dilation of the renal collecting system without evidence of stones.

Findings:

  • Indinavir's low urinary solubility is a critical factor in stone formation.
  • Elevated urinary pH and reduced citric acid excretion contribute to indinavir crystalluria.
  • Pharmacokinetic interactions and dehydration can exacerbate the risk of stone formation.

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Implications:

  • Patients on indinavir are at risk for a spectrum of urinary tract disorders, potentially impacting renal function.
  • Increased fluid intake and regular renal function monitoring are essential for all patients taking indinavir.
  • Urinary acidification and, in severe cases, emergency drainage may be necessary treatment and prevention strategies.