new_n_lost
Politically InCorrect
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A 31-year-old man with a 4-year history of HIV infection who takes zidovudine and lamivudine begins receiving indinavir to further reduce the viral load. He also continues taking trimethoprim-sulfamethoxazole 3 times weekly. Over the next 12 weeks, he develops nausea with vomiting, anorexia, and an episode of gross hematuria. Urinalysis results show hematuria and pyuria. Urine sediment examination shows crystals in various starburst and plate-like patterns. Serum BUN (54 mg/dL) and serum creatinine (2.5 mg/dL) are elevated. Indinavir is discontinued, and the patient receives an intravenous infusion of 0.9% saline.
Which of the following most likely caused his acute renal failure?
A) Acute tubular necrosis caused by indinavir
B) Allergic interstitial nephritis caused by trimethoprim-sulfamethoxazole
C) Indinavir-associated crystal-induced renal failure
D) Obstructive uropathy from retroperitoneal nodes caused by HIV-associated lymphoma
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| me007
Forum Guru
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C.
most common adverse effect along with hyperbilirubinemia.
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| new_n_lost
Politically InCorrect
Topics: 650
Posts: 6,058
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U nailed it Me007
[left](C) Indinavir-associated crystal-induced renal failure. Indinavir, a protease inhibitor, is commonly used to treat HIV infection. This drug causes crystal formation within the renal tubules when urine pH is above 3.5. Crystallization in the urine may lead to intrarenal crystal deposition and renal insufficiency. Asymptomatic crystalluria is sometimes noted in the absence of other clinical or laboratory signs of renal disease. Renal calculi manifested by flank pain and hematuria and more rarely obstructive uropathy from stone-related obstruction may occur during indinavir therapy. Acute tubular necrosis has not been described as a complication. Allergic interstitial nephritis is not supported by the clinical presentation or the presence of crystals in the urine. [/left]
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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