Papillary necrosis associated with the HIV protease inhibitor indinavir

The HIV protease inhibitor indinavir may cause nephrolithiasis and intersti tial nephritis. The renal consequences of indinavir-associated nephrotoxici ty are uncertain. We report a case of papillary necrosis in a patient treat ed with indinavir. An asymptomatic HIV-infected woman experienced right-sided renal colicky pa in during treatment with indinavir. She passed a non-solid stone and contin ued indinavir treatment. Intravenous pyelogram performed 20 months Later fo llowing an episode of left-sided colicky pain showed right-sided papillary necrosis. Indinavir-associated nephrolithiasis and chronic interstitial nep hritis were the only possible causes identified in this patient. Physicians should be aware that indinavir nephrolithiasis may cause papillary necrosi s.