Images in Clinical Medicine

Indinavir Crystalluria

Jack W. Tsao, M.D., D.Phil., and Scott C. Kogan, M.D.

N Engl J Med 1999; 340:1329April 29, 1999

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Figure 1 A 33-year-old man with hemophilia and the acquired immunodeficiency syndrome had a six-hour history of severe right-sided flank pain and right-lower-quadrant pain accompanied by nausea, vomiting, and anorexia. The patient was afebrile and euvolemic. His medications included zidovudine, lamivudine, and indinavir. A computed tomographic scan with the intravenous administration of contrast medium, obtained to assess the possibility of appendicitis and retroperitoneal bleeding, revealed a mildly dilated right renal collecting system. This finding was confirmed by x-ray examination of the kidneys and upper bladder (Panel A), which provides a view equivalent to that of intravenous pyelography. Urinalysis showed a specific gravity of 1.010, a pH of 5.0, and more than 50 red cells per high-power field. Compensated polarizing microscopy showed indinavir crystals in the urine (Panel B, ×100). To reduce the risk that the patient's strains of human immunodeficiency virus would become resistant if indinavir were withdrawn from the treatment regimen, the patient was instructed to continue taking the drug and to increase his fluid intake. Although his pain decreased initially, crystalluria persisted, and several weeks later, he returned with flank pain and hematuria. Ultrasonography at this time confirmed the development of several renal calculi. Treatment with indinavir was discontinued, and nelfinavir was added to his regimen of zidovudine and lamivudine. The renal calculi and crystalluria resolved spontaneously, and the patient was well at the time of the most recent follow-up visit.

Jack W. Tsao, M.D., D.Phil.
Scott C. Kogan, M.D.
University of California, San Francisco, San Francisco, CA 94143

Citing Articles (4)

Citing Articles

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   Carmin Marc Kalorin, Ross Bauer, Mark D. White. (2008) Phenytoin Metabolite Renal Calculus: An Index Case. Journal of Endourology 22:8, 1665-1668
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2. 2

   2006. Indinavir. , 1735-1739.
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3. 3

   Jeanne P. Dieleman, Saima Salahuddin, Yen Shen Hsu, David M. Burger, Inge C. Gyssens, Miriam C. J. M. Sturkenboom, Bruno H. Ch. Stricker, Dirk J. Kok. (2001) Indinavir Crystallization Around the Loop of Henle: Experimental Evidence. JAIDS Journal of Acquired Immune Deficiency Syndromes 28:1, 9-13
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4. 4

   S. P. Sparagana, W. R. Strand, R. C. Adams. (2001) Felbamate Urolithiasis. Epilepsia 42:5, 682-685
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