Atazanavir sulfate, an azapeptide inhibitor of HIV protease, has been associated with urolithiasis. A 60-year-old man with atazanavir-induced urinary sediment crystals verified by infrared spectroscopic analysis is described. He had been receiving highly active antiretroviral therapy (HAART) for HIV infection and also had a history of urinary lithiasis and been undergoing urinalysis once every month. Needle-shaped crystals were seen in his urine sediment and infrared spectroscopic analysis revealed that these were atazanavir crystals. Because the presence of the crystals in urine do not always reveal an abnormality in the urinary test strip analysis, the urinary sediment needed to be observed microscopically in order to prevent future urolithiasis and renal failure in this HIV patient receiving atazanavir.

Keywords:
Atazanavir, Urine crystals, Infrared spectroscopic analysis
1.
Hamm M, Wawroschek F, Rathert P: Urinary cytology changes in protease inhibitor induced urolithiasis. J Urol 2000;163:1249-1250.
2.
Chang HR, Pella PM: Atazanavir urolithiasis. N Engl J Med 2006;355:2158-2159.
3.
Moriyama Y, Minamidate Y, Yasuda M, Ehara H, Kikuchi M, Tsuchiya T, Deguchi T, et al: Acute renal failure due to bilateral ureteral stone impaction in an HIV-positive patient. Urol Res 2008;36:275-277.
4.
Izzedine H, M'Rad MB, Bardier A, Daudon M, Salmon D: Atazanavir crystal nephropathy. AIDS 2007;21:2357-2358.
5.
Gentle DL, Stoller ML, Jarrett TW, Ward JF, Geib KS, Wood AF: Protease inhibitor-induced urolithiasis. Urology 1997;50:508-511.
6.
Green ST, McKendrick MW, Schmid ML, Mohsen AH, Prakasam SF: Renal calculi developing de novo in a patient taking saquinavir. Int J STD AIDS 1998;9:555.
7.
Engeler DS, John H, Rentsch KM, Ruef C, Oertle D, Suter S: Nelfinavir urinary stones. J Urol 2002;167:1384-1385.
8.
Rockwood N, Mandalia S, Bower M, Gazzard B, Nelson M: Ritonavir-boosted atazanavir exposure is associated with an increased rate of renal stones compared with efavirenz, ritonavir-boosted lopinavir and ritonavir-boosted darunavir. AIDS 2011;25:1671-1673.
9.
Couzigou C, Daudon M, Meynard JL, Borsa-Lebas F, Higueret D, Escaut L, Zucman D, et al: Urolithiasis in HIV-positive patients treated with atazanavir. Clin Infect Dis 2007;45:e105-e108.
© 2013 S. Karger AG, Basel
2013
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