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Area of Science:

  • Nephrology
  • Infectious Diseases
  • Pharmacology

Background:

  • Atazanavir is a crucial component of combination antiretroviral therapy for HIV.
  • Atazanavir use is linked to potential renal complications, including crystalluria, urolithiasis, acute kidney injury (AKI), and chronic kidney disease (CKD).
  • Previous studies suggest an association between atazanavir/ritonavir, with or without tenofovir, and increased CKD risk, though renal biopsies were often lacking.

Purpose of the Study:

  • To review atazanavir-related kidney diseases, encompassing urolithiasis, renal dysfunction, and interstitial nephritis.
  • To present a case study of atazanavir-associated kidney injury with sequential renal biopsies.
  • To elucidate the mechanisms and clinical presentations of atazanavir nephrotoxicity.

Main Methods:

  • Literature review of atazanavir-associated kidney disease.
  • Case report presentation with detailed clinical and pathological findings.
  • Analysis of renal biopsies to identify atazanavir crystal precipitation and tubulointerstitial changes.

Main Results:

  • Atazanavir can precipitate as crystals in urine and renal tissues, leading to various kidney issues.
  • Two forms of atazanavir-associated tubulointerstitial nephritis are identified: acute (rapid onset AKI) and chronic (slowly progressive CKD).
  • Chronic tubulointerstitial nephritis may involve granuloma formation and intrarenal atazanavir crystal precipitation.

Conclusions:

  • Atazanavir nephrotoxicity manifests as crystalluria, urolithiasis, AKI, and CKD.
  • Clinicians should exercise caution when prescribing atazanavir to patients with pre-existing renal conditions.
  • Renal function monitoring and reevaluation of therapy are recommended if deterioration occurs, particularly with concurrent crystalluria and hematuria.