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Case 3: Indinavir Nephrotoxicity

You answered:

E The patient likely has HIV-associated nephropathy causing these acute symptoms.

This answer is incorrect. HIV-associated nephropathy does not cause symptoms similar to those seen in this patient. In most patients, HIV-associated nephropathy is characterized by nephrotic-range proteinuria and large, echogenic kidneys.

Choose another answer:

A 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).
B The absence of stones on the abdominal CT scan rules out nephrolithiasis caused by indinavir.
C The patient likely has indinavir-induced nephrolithiasis and should immediately be referred to urology for lithotripsy.
D 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.

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