[Drug-induced renal calculi].
Drug-induced renal calculi represent 1-2% of all renal calculi. They include two categories: those resulting from the urinary crystallisation of a highly excreted, poorly soluble drug or metabolite, and those due to the metabolic effects of a drug. Indinavir, used in HIV-infected patients, sulfonamides, especially sulfadiazine, and triamterene, which is less prescribed today, are the most frequent. Besides these drugs, about twenty other molecules, among them silicate-containing drugs and some antibiotics have been reported in patients receiving high doses or long-term treatments. Calculi analysis by physical methods such as infrared spectroscopy or x-ray diffraction can demonstrate the presence of the drug or its metabolites inside the calculi. In those calculi due to the metabolic effects of a drug, diagnosis relies on both stone analysis and clinical inquiry. Incidence of such calculi is probably underestimated, especially those due to calcium/vitamin D supplements or carbonic anhydrase inhibitors. Drug-induced calculi occur more often during high-dose or long term treatments, but there are also patient-related risk factors in relation to urine pH, urine output and other parameters, which can provide a basis for preventive treatment of such calculi. A better knowledge of these lithogenic complications of treatments and of solubility characteristics of drugs should reduce the incidence of drug-induced nephrolithiasis, especially in patients with identified risk factors.
Servais
A
A
Service de néphrologie adultes, hôpital Necker, université Paris V, 161, rue de Sèvres, 75015 Paris, France. aude.servais@nck.ap-hop-paris.fr
Daudon
M
M
Knebelman
B
B
D017320:HIV Protease Inhibitors / Q000009:adverse effects; D006801:Humans; D019469:Indinavir / Q000009:adverse effects; D007669:Kidney Calculi / Q000139:chemically induced* / Q000378:metabolism
D017320:HIV Protease Inhibitors; D019469:Indinavir