title: Recurrent nephrolithiasis associated with atazanavir use.
abstract: A 64-year-old man with HIV on antiretroviral therapy (including atazanavir, a protease inhibitor) presented with left flank pain, nausea and vomiting. A kidney stone was suspected, and a CT scan demonstrated left hydronephrosis but failed to demonstrate nephrolithiasis or extrinsic compression. The patient had a ureteral stent placed which relieved his symptoms. A few months later, he underwent left ureteroscopy and a large ureteral calculus was found. The stone was removed and analysis showed 43% atazanavir and 57% calcium oxalate. Several months later, the patient developed flank pain on the opposite side. A renal ultrasound suggested right-sided nephrolithiasis and he subsequently underwent ureteroscopy with laser lithotripsy of two stones. Stone analysis showed that they were composed of 100% atazanavir. This case highlights the fact that patients treated with protease inhibitors remain at risk for developing nephrolithiasis. Ultrasonography can be a useful diagnostic tool in the setting of these radiolucent calculi.
authors.affiliation: Department of Urology, New York Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA.
authors.forename: Lily C
authors.initials: LC
authors.lastname: Wang
authors.forename: E Charles
authors.initials: EC
authors.lastname: Osterberg
authors.forename: Scott G
authors.initials: SG
authors.lastname: David
authors.forename: James S
authors.initials: JS
authors.lastname: Rosoff
mesh_terms: D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000069446:Atazanavir Sulfate; D002129:Calcium Oxalate / Q000032:analysis; D015658:HIV Infections / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D017602:Lithotripsy, Laser; D008297:Male; D008875:Middle Aged; D053040:Nephrolithiasis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy; D009842:Oligopeptides / Q000009:adverse effects* / Q000032:analysis / Q000627:therapeutic use; D011725:Pyridines / Q000009:adverse effects* / Q000032:analysis / Q000627:therapeutic use; D012008:Recurrence; D015607:Stents; D014057:Tomography, X-Ray Computed; D014514:Ureteral Calculi / Q000139:chemically induced* / Q000737:chemistry / Q000000981:diagnostic imaging / Q000628:therapy; D018666:Ureteroscopy
chemical_list: D019380:Anti-HIV Agents; D009842:Oligopeptides; D011725:Pyridines; D002129:Calcium Oxalate; D000069446:Atazanavir Sulfate