Case 3: Indinavir Nephrotoxicity

Question | Discussion | References | CME Credit

You answered:

	The absence of stones on the abdominal CT scan rules out nephrolithiasis caused by indinavir.

This answer is incorrect. Renal stones caused by indinavir are composed of the actual drug and are radiolucent, thus not identified with a non-contrast CT scan. Occasionally, the stone may consist of indinavir combined with calcium oxalate in which case the stone may appear radiopaque.

Choose another answer:

	The patient probably had bacterial cystitis caused by an organism resistant to trimethoprim-sulfamethoxazole, and now the infection has evolved into pyelonephritis and should be treated with ciprofloxacin (Cipro).
	The patient likely has indinavir-induced nephrolithiasis and should immediately be referred to urology for lithotripsy.
	The patient likely has indinavir-induced nephrolithiasis and antiretroviral therapy should either temporarily be discontinued or the indinavir plus ritonavir should be changed to another protease inhibitor(s), such as lopinavir-ritonavir (Kaletra). The patient should initially be managed conservatively with hydration and pain control.
	The patient likely has HIV-associated nephropathy causing these acute symptoms.

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