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Protease
inhibitors are a new class of medication used to treat patients
with HIV disease. Indinavir sulfate (Crixivan), a protease inhibitor,
is widely used to treat patients with HIV infections. Urinary lithiasis
has been associated with the use of Indinavir. As with other renal
calculi, ureteral stents, hydration, analgesics, and antispasmodics
have provided favorable outcomes. Nonsteroidal-anti-inflammatory
drugs (NSAID) should be avoided as they have been shown to result
in deterioration of renal function. The formation of urinary lithiasis
is a frequent complication of Indinavir therapy resulting in stones
in 3-9% of patients. Hyperhydration and acidification of urine are
usually successful. However, emergency drainage is usually required
in 3% of cases. 20% of patients have been shown to have crystals
in the urine. 8% of patients had urologic symptoms (3% had nephrolithiasis,
5% had crystalluria associated with dysuria/back pain). Crystalluria
may be associated with dysuria and urinary frequency. Flank or back
pain is associated with intrarenal sludging and the classic syndrome
of renal colic. It is also believed that Crixivan stones may act
as a nidus for heterogenous nucleation leading to the development
of mixed urinary stones. Surgical intervention may be required in
some patients. In addition, a combined medical and surgical intervention
may be necessary. Indinavir therapy averaged 5.7 months prior to
presentation of renal colic. All patients presented with microscopic
hematuria. The median number of symptomatic urinary stone episodes
after initiating Indinavir was 2 stones per patients. Radiographically,
Indinavir stones are typically radiolucent. Abdominal CT scan demonstrated
hydronephrosis without calcifications. CT scan with contrast may
demonstrate the presence of crixivan stones. These stones can cause
high grade ureteral obstruction. The radiolucent-gelatinous nature
of such stones makes lithotripsy a poor choice of treatment.
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