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The Etiology of Urolithiasis in HIV Infected Patients

2003; Lippincott Williams & Wilkins; Volume: 169; Issue: 2 Linguagem: Inglês

10.1016/s0022-5347(05)63936-5

1527-3792

Robert B. Nadler, Jonathan N. Rubenstein, Scott E. Eggener, MICHELLE M. LOOR, Norm D. Smith,

Renal function and acid-base balance

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Feb 2003The Etiology of Urolithiasis in HIV Infected Patients ROBERT B. NADLER, JONATHAN N. RUBENSTEIN, SCOTT E. EGGENER, MICHELLE M. LOOR, and NORM D. SMITH ROBERT B. NADLERROBERT B. NADLER Requests for reprints: Department of Urology, Tarry 11-715, Northwestern University Medical School, 303 E. Chicago Ave., T-229, Chicago, Illinois 60611-3008. More articles by this author , JONATHAN N. RUBENSTEINJONATHAN N. RUBENSTEIN More articles by this author , SCOTT E. EGGENERSCOTT E. EGGENER More articles by this author , MICHELLE M. LOORMICHELLE M. LOOR More articles by this author , and NORM D. SMITHNORM D. SMITH More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)63936-5AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: It is commonly thought that urinary lithiasis in HIV infected patients on protease inhibitor therapy is composed primarily of the protease inhibitor itself. Since many HIV infected patients on protease inhibitors presenting to our institution had nonprotease inhibitor stones, we investigated potential underlying metabolic abnormalities that may account for the lithogenesis. Materials and Methods: We retrospectively reviewed all HIV infected patients on protease inhibitors with renal colic and evidence of nephrolithiasis who presented to our institution between June 1996 and January 2001. Patients were evaluated for stone composition and metabolic abnormalities of blood and urine when possible. Results: A total of 24 patients were identified, and all were or had been on protease inhibitors (indinavir 14, ritonavir 3, nelfnavir 2, unspecified 5). Of the 14 patients on indinavir only 4 (28.6%) had indinavir containing stones. The remaining stones in this group and in those not on indinavir contained various amounts of calcium oxalate monohydrate and dihydrate, ammonium acid urate and uric acid. Of 10 patients who underwent 24-hour urine collection for metabolic evaluation 8 (80%) had abnormalities, including hypocitraturia in 5, hyperoxaluria in 4, hypomagnesuria in 4, hypercalciuria in 3, increased supersaturation of calcium oxalate in 3 and hyperuricosuria in 2. Abnormalities in the levels of urinary phosphate and sodium were also observed. Conclusions: HIV infected patients form many types of stones, which probably are attributable to underlying metabolic abnormalities rather than the use of protease inhibitors. A complete metabolic evaluation is warranted in these patients, as a means of guiding treatment to prevent future stone episodes, while avoiding the need to alter antiretroviral regimens. References 1 : Protease inhibitor-induced urolithiasis. Urology1997; 50: 508. Google Scholar 2 : Urolithiasis associated with protease inhibitors. J Endourol1999; 13: 309. Google Scholar 3 : Protease inhibitors show promise in HIV infection. Lancet1996; 347: 383. Google Scholar 4 : Variation in incidence of indinavir-associated nephrolithiasis among HIV-positive patients. AIDS1998; 12: 2433. Google Scholar 5 : Frequency of urolithiasis in individuals seropositive for human immunodeficiency virus treated with indinavir is higher than previously assumed. J Urol1999; 161: 1082. Link, Google Scholar 6 : Protease inhibitors and urolithiasis. J Urol1997; 158: 31. Link, Google Scholar 7 : Increased incidence of indinavir nephrolithiasis in patients with hepatitis B or C virus infection. Antivir Ther2000; 5: 3. Google Scholar 8 : Imaging characteristics of indinavir calculi. J Urol1999; 161: 1085. Link, Google Scholar 9 : Persistent nephrolithiasis after discontinuation of indinavir therapy. Clin Infect Dis1998; 27: 1536. Google Scholar 10 : Management of indinavir associated nephrolithiasis. J Urol1997; 158: 2228. Link, Google Scholar 11 : Prospective study of urinalysis abnormalities in HIV-positive individuals treated with indinavir. Am J Kidney Dis2000; 36: 507. Google Scholar From the Department of Urology, Northwestern University Medical School, Chicago, Illinois© 2003 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byMoreira D, Friedlander J, Hartman C, Elsamra S, Smith A and Okeke Z (2018) Using 24-Hour Urinalysis to Predict Stone TypeJournal of Urology, VOL. 190, NO. 6, (2106-2111), Online publication date: 1-Dec-2013. Volume 169Issue 2February 2003Page: 475-477 Advertisement Copyright & Permissions© 2003 by American Urological Association, Inc.KeywordsHIVprotease inhibitorskidney calculiMetricsAuthor Information ROBERT B. NADLER Requests for reprints: Department of Urology, Tarry 11-715, Northwestern University Medical School, 303 E. Chicago Ave., T-229, Chicago, Illinois 60611-3008. More articles by this author JONATHAN N. RUBENSTEIN More articles by this author SCOTT E. EGGENER More articles by this author MICHELLE M. LOOR More articles by this author NORM D. SMITH More articles by this author Expand All Advertisement PDF downloadLoading ...