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[Indinavir urolithiasis in HIV-positive patients. Treatment and prophylaxis]
C Kalaitzis1, S Touloupidis, E Patris
1Department of Urology, Democritus University of Thrace, Dragana, 68100 Alexandroupolis, Greece. chkalaitzis@hotmail.com
Target:
The approximate incidence of indinavir urolithiasis in HIV positive patients receiving the drug is 10%. The exact mechanism of lithogenesis is still unknown. Pure indinavir stones are radiolucent on plane abdominal X-ray or CT scan. Indinavir urolithiasis can be associated with acute unilateral renal colic or severe azotaemia.
Material And Methods:
20 HIV patients were treated conservatively by increasing oral fluid intake (urine production of 2 l/day and more), discontinuation of indinavir therapy for 1 week and acidification of urine with l-methionin (urine pH 5,3-5,8). Some patients were additionally treated with endoscopic procedures.
Results:
In all patients renal function normalized. Increase of oral fluid intake, especially during the first 2 hours after intake of indinavir and during night prevented recurrence of indinavir urolithiasis.
Conclusion:
HIV positive patients with renal colic or renal insufficiency and roentgenological absence of radio-opaque stone formations should make the urologist consider indinavir urolithiasis as a possible diagnosis.