Urolithiasis Associated With Indinavir in A Patient With Spinal Cord Injury

Abstract

Objective: To report a case of indinavir-induced urolithiasis, and the greater risk of this occurrence in individuals with spinal cordinjury (SCI) who require fluid restriction for an intermittent catheterization program (ICP).

Methods: Case report.

Results: A 38-year-old man with a T4 ASIA A SCI (according to the American Spinal lnjury Association classification scale) and human immunodeficiency virus (HIV) infection wasusing an ICP and taking indinavir (a protease inhibitor) as part of his antiviralregimen.Cystoscopy was performed to rule out recurrent urethral condylomata. He was found to haveabladder stone measuring 0.5cm × 0.5 cm × 0.3 cm, which, on analysis, was composed ofindinavir (100% exterior, 90% interior). The bladder stone wasremoved under direct visualization. The plain abdominal radiograph did not reveal any stones.

Conclusion: lndinavir is a frequently used drug for the treatment of HIV that has the potential to induce urinary Iithiasis. This isparticularly problematic for individuals with SCI who are on fluid restriction and an ICP. Therefore, cystoscopy and monitaring forindinavir-induced urolithiasis should be undertaken in individuals with SCI who are takingindinavir. Considerations include switchingto a different protease inhibitor or choosing an entirely new HIV drug cocktail with less potential for urolithiasis.