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Crystalluria and urinary tract abnormalities associated with indinavir

J B Kopp1, K D Miller, J A Mican

  • 1National Institute of Diabetes and Digestive and Kidney Diseases, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.

Annals of Internal Medicine
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Summary

Indinavir medication can cause unique urinary crystals in HIV patients, potentially leading to kidney stones and urinary symptoms. Monitoring for these crystals is crucial for managing patient health.

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Area of Science:

  • Nephrology
  • Infectious Diseases
  • Pharmacology

Background:

  • Indinavir, a protease inhibitor for HIV, is linked to kidney problems like nephrolithiasis.
  • Distinctive urinary crystals and urologic issues have been observed in patients on indinavir therapy.

Purpose of the Study:

  • To identify the composition of urinary crystals in patients receiving indinavir.
  • To determine the frequency of asymptomatic crystalluria and urinary tract symptoms in this patient group.

Main Methods:

  • Analysis of urine specimens from HIV patients undergoing indinavir treatment.
  • Utilized microscopic urinalysis, HPLC, and mass spectrometry to characterize urinary crystals and stones.
  • Clinical evaluation of patients for urologic symptoms.

Main Results:

  • Indinavir crystals were identified in 20% of analyzed urine samples from patients on the drug.
  • Compared to controls, indinavir crystals were significantly more prevalent (P < 0.001).
  • 8% of patients on indinavir developed urologic symptoms, including nephrolithiasis (3%) and novel syndromes (5%).

Conclusions:

  • Indinavir forms characteristic crystals in urine, a condition known as crystalluria.
  • This crystalluria can manifest as dysuria, urinary frequency, flank/back pain, and renal colic.
  • Intrarenal sludging was observed in some patients experiencing flank or back pain.