Ascher D P, Lucy M D
Department of Pediatrics, Wilford Hall Medical Center, San Antonio, TX, USA.
Ann Pharmacother. 1997 Oct;31(10):1146-9. doi: 10.1177/106002809703101005.
To report a case of renal toxicity associated with administration of indinavir sulfate in a pediatric hemophiliac with HIV infection.
A 16-year-old white hemophiliac boy with HIV infection secondary to tainted coagulation factor VIII was treated with indinavir sulfate. The patient developed gross hematuria, proteinuria, pyuria, abdominal pain, increased bilirubin, an elevated serum creatinine (SCr) of 1.2 mg/dL (baseline 0.9-1.0), and symptoms of renal colic within 1 month of starting indinavir sulfate therapy. Approximately 2 months later the patient developed a low-grade fever with a further increase in SCr. He was prescribed a 10-day course of cefpodoxime proxetil for a possible urinary tract infection. One week later, the patient developed fever, chills, nausea, vomiting, decreased appetite, sterile pyuria, nasal congestion, and an elevated SCr of 1.3-1.7 mg/dL. Indinavir sulfate and cefpodoxime proxetil were discontinued and the patient was suspected of having tubulointerstitial nephritis secondary to indinavir sulfate. The patient's nephritis resolved and the SCr decreased to 1.1 mg/dL within 1 month of discontinuing indinavir sulfate.
This case demonstrates the potential for renal toxicity with the use of indinavir sulfate in HIV-infected hemophiliacs.
报告1例感染人类免疫缺陷病毒（HIV）的儿科血友病患者使用硫酸茚地那韦后出现肾毒性的病例。
一名16岁白人血友病男孩，因受污染的凝血因子VIII继发感染HIV，接受硫酸茚地那韦治疗。在开始硫酸茚地那韦治疗的1个月内，患者出现肉眼血尿、蛋白尿、脓尿、腹痛、胆红素升高、血清肌酐（SCr）从基线值0.9 - 1.0 mg/dL升至1.2 mg/dL，以及肾绞痛症状。大约2个月后，患者出现低热，SCr进一步升高。因可能存在尿路感染，他接受了为期10天的头孢泊肟酯治疗。1周后，患者出现发热、寒战、恶心、呕吐、食欲减退、无菌性脓尿、鼻塞，SCr升至1.3 - 1.7 mg/dL。停用硫酸茚地那韦和头孢泊肟酯，怀疑患者患有硫酸茚地那韦继发的肾小管间质性肾炎。停用硫酸茚地那韦1个月内，患者的肾炎得到缓解，SCr降至1.1 mg/dL。
该病例表明，感染HIV的血友病患者使用硫酸茚地那韦有发生肾毒性的可能。
