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Indinavir and Interstitial Nephritis
- Mario Sarcletti, MD;
- Anton Petter, MD; and
- Robert Zangerle, MD
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TO THE EDITOR:
Kopp and colleagues [1] report that indinavir crystalluria is associated with a novel syndrome that consists primarily of back or flank pain with crystalluria but without nephrolithiasis. In four of the patients who had this syndrome, renal parenchymal defects were shown on computed tomography. The authors argue that it is unknown whether patients with this complication subsequently develop chronic deficits in renal function, because serum creatinine levels were only mildly and transiently elevated in two of the patients. However, therapy was discontinued permanently in two patients and continued at a lower dose in another. Only one male patient continued therapy without a change in dosage. Did this patient have renal dysfunction? Did he increase fluid intake?
The risk for the syndrome described by Kopp and colleagues is evidently increasing with time (more patients were mentioned in a note in proof) and is presumably higher in women. However, the authors did not seem to be aware of this finding.
Tashima and coworkers [2] describe a woman who had back pain and renal insufficiency while receiving indinavir. Renal biopsy showed interstitial nephritis and plate-like crystals within cortical and medullary collecting ducts. Serum creatinine levels returned to normal after indinavir therapy was discontinued.
We describe a 32-year-old woman who first reported flank pain after 4 weeks of indinavir therapy and intermittently thereafter. Between week 12 and week 34, the patient's serum creatinine levels increased progressively from 1.2 to 2.1 mg/dL. Workup revealed persistent pyuria, normal-sized kidneys, unremarkable results on an intravenous pyelogram, and negative urinary cultures. Renal biopsy showed interstitial nephritis and chronic inflammation. Two months after treatment with indinavir was discontinued, serum creatinine levels returned to normal and pyuria disappeared. A relation between the histologic (interstitial nephritis) and the radiographic (parenchymal defects) findings in the study of Kopp and colleagues is unclear but warrants urgent investigation.
Mario Sarcletti, MD
Anton Petter, MD
Robert Zangerle, MD
University of Innsbruck; 6020 Innsbruck, Austria
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
