Indinavir nephropathy revisited: A pattern of insidious renal failure withidentifiable risk factors

Indinavir is a well-known cause of crystal-induced acute renal failure, dys uria and flank pain, and nephrolithiasis. Recently a more Insidious tubuloi nterstitial lesion has been recognized as secondary to the drug. We report a case of a hepatitis C-positive patient on long-term indinavir therapy for human immunodeficiency virus (HIV) who developed a slowly progressive rise in serum creatinine. Renal biopsy revealed a diffuse interstitial infiltra te with numerous eosinophils and scarring. The tubules showed focal necrosi s and dilation with elongated crystals present within their lumina. The ele vated serum creatinine decreased to a new baseline over several months with the discontinuation of Indinavir. We review the literature of renal syndro mes associated with indinavir focusing on chronic progressive tubulointerst itial Injury and speculate on risk factors and potential mechanisms of indi navir-induced renal injury. (C) 2001 by the National Kidney Foundation, Inc .