Deray G, Bochet M, Katlama C, Bricaire F
Service de Néphrologie, Groupe hospitalier Pitié-Salpêtrière, Paris.
Presse Med. 1998 Nov 14;27(35):1801-3.
Ritonavir is an antiprotease used in the treatment of HIV-positive patients. Among the known side effects, nephrotoxicity can be severe. We have observed acute renal failure in 8 patients. CIRCUMSTANCES: Renal failure occurs early after introducing ritonavir (3-21 days). It is often severe with major creatinine elevation. One patient was dialyzed for 16 days. In these patients, saquinavir was usually associated with ritonavir. RITONAVIR ALONE: We retrospectively analyzed creatinine levels in 87 patients treated with ritonavir without saquinavir. Twelve of these 87 patients (13.7%) developed renal failure. Creatinine clearance (Cockcroft) was reduced 116 to 71 ml/min in 12 patients. Finally, it was demonstrated in 6 patients that ritonavir can reduce creatinine clearance by 25% after only 3 days of treatment. VIGILANCE: Ritonavir has a known nephrotoxic potential. Acute renal failure may be severe and can occur with ritonavir alone or in combination with saquinavir. The pathogenic mechanism has not been demonstrated from renal biopsies or experimental studies. Renal function should be followed in these patients and risk factors controlled.
利托那韦是一种用于治疗HIV阳性患者的抗蛋白酶药物。在已知的副作用中，肾毒性可能很严重。我们观察到8例患者出现急性肾衰竭。情况：肾衰竭在引入利托那韦后早期发生（3 - 21天）。通常很严重，肌酐显著升高。1例患者接受了16天的透析治疗。在这些患者中，沙奎那韦通常与利托那韦联合使用。单独使用利托那韦：我们回顾性分析了87例接受利托那韦单药治疗而未使用沙奎那韦的患者的肌酐水平。这87例患者中有12例（13.7%）发生肾衰竭。12例患者的肌酐清除率（Cockcroft法）从116降至71 ml/分钟。最后，在6例患者中证实，仅治疗3天利托那韦就能使肌酐清除率降低25%。警惕：利托那韦具有已知的肾毒性潜能。急性肾衰竭可能很严重，可单独由利托那韦或与沙奎那韦联合使用引发。肾活检或实验研究尚未证实其致病机制。应对这些患者的肾功能进行监测并控制危险因素。
