[Indinavir urolithiasis in HIV-positive patients. Treatment and prophylaxis].
OBJECTIVE
The approximate incidence of indinavir urolithiasis in HIV positive patients receiving the drug is 10%. The exact mechanism of lithogenesis is still unknown. Pure indinavir stones are radiolucent on plane abdominal X-ray or CT scan. Indinavir urolithiasis can be associated with acute unilateral renal colic or severe azotaemia.


METHODS
20 HIV patients were treated conservatively by increasing oral fluid intake (urine production of 2 l/day and more), discontinuation of indinavir therapy for 1 week and acidification of urine with l-methionin (urine pH 5,3-5,8). Some patients were additionally treated with endoscopic procedures.


RESULTS
In all patients renal function normalized. Increase of oral fluid intake, especially during the first 2 hours after intake of indinavir and during night prevented recurrence of indinavir urolithiasis.


CONCLUSIONS
HIV positive patients with renal colic or renal insufficiency and roentgenological absence of radio-opaque stone formations should make the urologist consider indinavir urolithiasis as a possible diagnosis.
Department of Urology, Democritus University of Thrace, Dragana, 68100 Alexandroupolis, Greece. chkalaitzis@hotmail.com
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Kalaitzis
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Touloupidis
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Patris
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Lehrich
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Kuntz
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy*; D000328:Adult; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D019469:Indinavir / Q000008:administration & dosage* / Q000009:adverse effects*; D008297:Male; D008715:Methionine / Q000627:therapeutic use*; D008875:Middle Aged; D016896:Treatment Outcome; D014545:Urinary Calculi / Q000188:drug therapy* / Q000209:etiology* / Q000517:prevention & control
D017320:HIV Protease Inhibitors; D019469:Indinavir; D008715:Methionine