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Recurrent nephrolithiasis associated with atazanavir use.

Lily C Wang¹, E Charles Osterberg, Scott G David

¹Department of Urology, New York Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA.

BMJ Case Reports

|January 10, 2014

Summary

Patients on protease inhibitor antiretroviral therapy can develop kidney stones, including those made entirely of atazanavir. Ultrasonography is a useful tool for diagnosing these radiolucent calculi.

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Area of Science:

Nephrology
Pharmacology
Infectious Diseases

Background:

Antiretroviral therapy (ART) is crucial for managing Human Immunodeficiency Virus (HIV).
Protease inhibitors (PIs), such as atazanavir, are a key component of some ART regimens.
Kidney stones (nephrolithiasis) can be a potential complication of certain medications.

Observation:

A 64-year-old male with HIV on atazanavir presented with flank pain, nausea, and vomiting.
Initial CT scan showed hydronephrosis but not stones; ureteral stent placement provided symptom relief.
Subsequent ureteroscopy revealed a large ureteral calculus composed of atazanavir and calcium oxalate.

Findings:

The patient later developed contralateral flank pain and was diagnosed with right-sided nephrolithiasis.
Ureteroscopy identified two stones composed entirely of atazanavir.
This case demonstrates atazanavir-induced nephrolithiasis, including pure atazanavir stones.

Implications:

Patients on protease inhibitors, particularly atazanavir, are at risk for developing nephrolithiasis.
Atazanavir stones can be radiolucent, posing diagnostic challenges for conventional imaging.
Renal ultrasonography is a valuable tool for detecting these radiolucent calculi in at-risk patients.