UROLITHIASIS ASSOCIATED WITH THE PROTEASE INHIBITOR INDINAVIR

Objectives. To report the association between the protease inhibitor i ndinavir and the development of urolithiasis. Methods. Case reports of three adult patients infected with the human immunodeficiency virus w ho developed surgical renal stones while being treated with indinavir are presented. Results. Of the 3 patients requiring surgical intervent ion, stone analyses were available in 2. One stone revealed an inner c ore of an unidentifiable crystal surrounded by calcium oxalate, and an other was found to have indinavir components as determined by thin-lay er chromatography and gas chromatography-mass spectrometry. Metabolic evaluation of all 5 patients identified significant hypocitraturia as an isolated finding. Conclusions. The widely used protease inhibitor i ndinavir is associated with the development of urolithiasis and may ac t as a nidus for heterogeneous nucleation leading to the development o f mixed urinary stones. Surgical intervention may be necessary in some cases. Underlying metabolic abnormalities may contribute to the incre ased incidence of stone formation. Urologists and other health care pr oviders should be aware of this association, as combined medical and s urgical intervention may be necessary. (C) 1997, Elsevier Science Inc. All rights reserved.