Kidney non-tumor - Indinavir nephropathy

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Kidney non-tumor

Drug related toxicity

Indinavir nephropathy

Reviewers: Nikhil Sangle, M.D. (see Reviewers page)
Revised: 2 September 2012, last major update September 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Protease inhibitor used to treat HIV, strongly associated with direct nephrotoxicity (Adv Chronic Kidney Dis 2010;17:72)
● May cause tubulointerstitial nephritis due to intratubular precipitation of indinavir crystals, with damage to tubular epithelial cells and histiocytic reaction
● Tolerance may be higher in those from sub-Saharan Africa versus US / Europe (AIDS Res Hum Retroviruses 2007;23:62)
● May resemble tuberculosis (Braz J Infect Dis 2008;12:99)

Case reports
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● 49 year old man with HIV and indinavir-induced nephrolithiasis 3 years after discontinuing indinavir (Int Urol Nephrol 2011;43:571)

Treatment
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● Dose reduction (Eur J Clin Pharmacol 2007;63:901), discontinuation, urine acidification, early insertion of bilateral double-J ureteral stents (Int Urol Nephrol 2007;39:743)

Micro images
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Biopsy findings

Crystal induced tubular injury

Indinavir crystals in urinary sediment

Electron microscopy images
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Granulomatous giant cell reaction with crystals within lumen

End of Kidney non-tumor > Drug related toxicity > Indinavir nephropathy

Ref Updated: 7/13/12

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