ACYCLOVIR INDUCED RENAL-FAILURE IN THE TREATMENT OF PRESUMED VIRAL RETINITIS

Seven university teaching hospitals or retina subspecialty clinics wit h published experience in the treatment of viral retinitis were survey ed to identify cases of acyclovir-induced nephrotoxicity. Four patient s from three university teaching hospitals were identified. These four patients, who were presumed to have viral retinitis and normal renal function, developed acute oliguric renal failure between 48 and 72 hou rs after the initiation of high-dose (500 mg/m(2) or 10 mg/kg every ei ght hours) intravenous acyclovir. Peak serum creatinine concentrations ranged from 3.4 mg/dL to 7 mg/dL. In three of the four patients, rena l function returned to normal between four and seven days after discon tinuation of the acyclovir. Reduced dosage of either intravenous or or al acyclovir was not associated with recrudescence of the acute renal failure in any of these three patients. The authors' findings suggest that renal function should be monitored routinely in patients receivin g high-dose intravenous acyclovir for the treatment of presumed viral retinitis and that reduction of the acyclovir dose frequently results in resolution of the acute renal failure despite continued treatment o f the viral retinitis.