title: Prospective study of urinalysis abnormalities in HIV-positive individuals treated with indinavir.
abstract: Indinavir is a potent protease inhibitor widely used in combination with reverse-transcriptase inhibitors to treat human immunodeficiency virus (HIV) disease. Individuals treated with indinavir are prone to develop urinary complications, including renal colic, renal calculi, lower urinary tract symptoms, and indinavir crystalluria. Although renal stones secondary to indinavir have been described and characterized, little is known about the onset, frequency, and significance of the crystalluria. To document the longitudinal characteristics of indinavir crystalluria and associated urine abnormalities, 54 asymptomatic indinavir-naive HIV-positive individuals had urinalysis testing initially weekly and then monthly during the first year of indinavir treatment. Six hundred eight urinalyses were performed (11 +/- 2 urinalysis/subject), including 579 microscopy examinations performed by a nephrologist (10 +/- 2 examinations/subject). Baseline urinalysis results were essentially normal. After the start of treatment, indinavir crystalluria was frequently observed (67% of subjects). After the first 2 weeks, indinavir crystalluria remained constant at a frequency of approximately 25% of urine sediments examined at each test point. Other urine abnormalities, principally leukocytes (>/=10/high-power field) and casts, were observed in 39% of subjects. These abnormalities were more severe in five subjects, with concomitant increasing serum creatinine levels in three of them. Additional urine findings include the predominance of low pH (</=5. 5 in 72% of urinalyses) and high specific gravity (>/=1.025 in 66% of urinalyses). In conclusion, abnormal urinalysis results were noted frequently during the first year of treatment with indinavir. The main findings were the high proportion of subjects with crystalluria and the relatively high frequency of crystalluria observed consistently throughout. These findings may occasionally be associated with other urine abnormalities, presumably secondary to indinavir crystalluria.
authors.affiliation: Departments of Medicine and Pathology, The Montreal General Hospital, Montreal, Quebec, Canada. raymonde.gagnon@muhc.mcgill.ca
authors.forename: R F
authors.initials: RF
authors.lastname: Gagnon
authors.forename: S N
authors.initials: SN
authors.lastname: Tecimer
authors.forename: A K
authors.initials: AK
authors.lastname: Watters
authors.forename: C M
authors.initials: CM
authors.lastname: Tsoukas
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003460:Crystallization; D005260:Female; D017320:HIV Protease Inhibitors / Q000009:adverse effects* / Q000737:chemistry / Q000652:urine; D006679:HIV Seropositivity / Q000188:drug therapy* / Q000652:urine*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D019469:Indinavir / Q000009:adverse effects* / Q000737:chemistry / Q000652:urine; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009391:Nephelometry and Turbidimetry; D011446:Prospective Studies; D013046:Specific Gravity; D016482:Urinalysis
chemical_list: D017320:HIV Protease Inhibitors; D019469:Indinavir