Case 3: Indinavir Nephrotoxicity

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Question | Discussion | References | CME Credit

You answered:

	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.

This answer is correct. Conservative management with hydration and discontinuation of antiretroviral therapy for 1 to 3 days is effective in most cases of indinavir-induced nephrolithiasis. Considering that lopinavir-ritonavir (Kaletra) does not cause renal stones and is an extremely effective protease inhibitor, it would be reasonable to change the indinavir plus ritonavir to lopinavir-ritonavir.

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