[Nephritic colic due to indinavir].
OBJECTIVE
Evaluate the frequency and assess curative and preventive measures against urinary lithiasis in patients treated with indinavir.


METHODS
Fourteen HIV seropositive patients who developed severe and acute flank pain were included. Four of the patients receiving 800 mg indinavir t.i.d. had fever (38.5 degrees C) or delayed secretion (> 2 h). Delay from indinavir treatment onset was 1 to 321 days. During the same period, 155 patients had been treated with indinavir. Clinical features, radiology and laboratory results were recorded in addition to an analysis of the lithiasis if possible.


RESULTS
Transient moderate renal failure occurred in 8 patients. Mean urine pH was 6. Serum phosphorus, calcium, and uric acid, liver tests and urinalysis were normal. A JJ ureteral stent was inserted in 4 cases due to complications. In all cases, fluids, analgesics and antispasmodics provided favorable outcome. Inversely, nonsteroid antiinflammatory drugs given in 2 patients had a deleterious effect on renal function. The lithiasis was eliminated in 3 cases and infrared spectrophotometry demonstrated a structure compatible with indinavir monohydrate.


CONCLUSIONS
The formation of urinary lithiasis is a frequent complication of indinavir therapy (9%). Hyperhydration and urine acidification are usually successful but emergency drainage is required in approximately 3% of cases. Nonsteroidal antiinflammatory drugs should be avoided due to the risk of renal toxicity. A precise evaluation of fluid intake and diet, drug associations and personal history is needed to recognize patients at risk of recurrent lithiasis formation.
Clinique Urologique, Hôpital Bichat, Paris.
J F
JF
Hermieu
M H
MH
Prévot
V
V
Ravery
F
F
Moulinier
V
V
Delmas
E
E
Bouvet
L
L
Boccon-Gibod
D058186:Acute Kidney Injury / Q000139:chemically induced; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000032:analysis; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D002118:Calcium / Q000097:blood; D003085:Colic / Q000139:chemically induced* / Q000517:prevention & control / Q000628:therapy; D005069:Evaluation Studies as Topic; D005260:Female; D005440:Fluid Therapy; D017320:HIV Protease Inhibitors / Q000009:adverse effects* / Q000032:analysis; D006801:Humans; D006863:Hydrogen-Ion Concentration; D019469:Indinavir / Q000009:adverse effects* / Q000032:analysis; D007669:Kidney Calculi / Q000139:chemically induced / Q000737:chemistry / Q000517:prevention & control / Q000628:therapy; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010276:Parasympatholytics / Q000627:therapeutic use; D010758:Phosphorus / Q000097:blood; D013055:Spectrophotometry, Infrared; D014527:Uric Acid / Q000097:blood; D014556:Urine
D000700:Analgesics; D019380:Anti-HIV Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D017320:HIV Protease Inhibitors; D010276:Parasympatholytics; D014527:Uric Acid; D010758:Phosphorus; D019469:Indinavir; D002118:Calcium
Coliques néphrétiques sous indinavir.