| Urolithiasis/ nephrolithiasis |
IDV, ATV |
Onset:
Weeks to months after starting therapy
Clinical findings:
Crystalluria, hematuria, pyuria, flank pain, sometimes increased creatinine
|
IDV-related nephrolithiasis is more common in adults (4%–43%) than in children (0%–20%).
ATV nephrolithiasis rare
|
In adults, high serum IDV concentrations and elevated urine pH (>5.7) associated with persistent pyuria.
Unknown in children.
|
Prevention:
Maintain adequate hydration.
Monitoring:
Obtain urinalysis at least every 6–12 months.
|
Provide adequate hydration and pain control; consider using alternative ARV agent. |
Renal
dysfunction |
TDF |
Onset:
Variable; in adults, weeks to months after initiation of therapy. Hypophosphatemia appears at a median of 18 months.
Presentation:
Renal failure, acute tubular necrosis, Fanconi syndrome, proximal renal tubulopathy, interstitial nephritis (including acute cases), nephrogenic diabetes insipidus, renal insufficiency, increased creatinine, proteinuria, polyuria
|
Adults:
~2% with increased serum creatinine; ~0.5% with severe renal complications
Children:
~4% with hypophosphatemia or proximal tubulopathy;
25% to 78% with severe proteinuria (may be confounded by advanced HIV infection in children studied, and concomitant use of ddI)
|
Risk may be increased in children aged >6 years, black race, Hispanic/Latino ethnicity, and by advanced HIV infection, concurrent use of ddI or PIs (especially LPV/r), and pre-existing renal dysfunction). |
Urinalysis, measurement of serum creatinine, calcium, and phosphorus and determination of spot urine protein/creatinine ratios at least every 6–12 months. |
If TDF is the likely cause, consider using alternative medication. |