Acute tubulointerstitial nephritis attributable to indinavir therapy

Indinavir sulfate has been reported to cause asymptomatic crystalluria and nephrolithiasis in patients with human immunodeficiency virus (HIV) infecti on. Patients taking indinavir may present with asymptomatic crystalluria, n ephrolithiasis with frank renal colic and obstruction, flank pain in the ab sence of nephrolithiasis, and dysuria or urgency, Asymptomatic crystalluria has been described as benign. Discontinuation of the drug has not been rec ommended in the absence of nephrolithiasis. We report two HIV-positive pati ents receiving indinavir who developed acute interstitial nephritis with fo reign body giant cell reaction on renal biopsies. Both patients had asympto matic crystalluria, although crystals were associated with clumps of white blood cells (WBCs) on urinalysis in one patient. Both cases show that the i nflammatory response was significant enough to lead to tubular injury and a cute renal impairment. Our findings suggest that asymptomatic crystalluria attributable to indinavir may illicit an inflammatory response with acute r enal insufficiency, warranting monitoring of renal function, especially in patients with crystalluria, (C) 2000 by the National Kidney Foundation, Inc .