[Drug-induced renal calculi].

Area of Science:

• Nephrology
• Pharmacology
• Urology

Context:

• Drug-induced renal calculi constitute a small but significant percentage (1-2%) of all kidney stones.
• These calculi are categorized into two main types: those formed by urinary crystallization of drugs/metabolites and those resulting from drug-induced metabolic changes.
• Common culprits include indinavir, sulfonamides (e.g., sulfadiazine), and triamterene, with other drugs like certain antibiotics and silicate-containing medications also implicated.

Purpose:

• To review the etiology, diagnosis, and prevention of drug-induced renal calculi.
• To highlight the importance of drug properties and patient-specific factors in calculus formation.
• To emphasize the potential underestimation of drug-induced nephrolithiasis incidence.

Summary:

• Diagnosis involves physical methods (infrared spectroscopy, X-ray diffraction) for stone analysis, especially for drug crystallization types, and clinical inquiry for metabolic effect types.
• High-dose or long-term drug treatments increase risk, alongside patient-related factors such as urine pH and output.
• Calcium/vitamin D supplements and carbonic anhydrase inhibitors are examples of drugs potentially contributing to underdiagnosed calculi.

Impact:

• Improved understanding of drug solubility and lithogenic potential can reduce the incidence of drug-induced nephrolithiasis.
• Identifying patient risk factors allows for targeted preventive strategies.
• This knowledge is crucial for optimizing patient safety during pharmacotherapy, particularly for those on long-term or high-dose medications.