For the patient on ART, what drugs are most likely to cause renal disease?
Adverse drug reactions that cause renal disease are most commonly associated with aminoglycosides, amphotericin, foscarnet, and cidofovir. The antiretroviral agent that is most frequently implicated is indinavir (IDV), which may cause indinavir crystals in the collection system, resulting in nephrolithiasis. The presentation may be renal colic, or it may be asymptomatic with evidence of crystals on urinalysis. In addition, indinavir can cause a crystal-induced nephropathy. On rare occasions, tenofovir (TDF) may cause renal insufficiency. What are the cause and implications of HIV-associated nephropathy? HIV-associated nephropathy, which is apparently the result of HIV infection of the kidney, presents as large, echogenic kidneys on ultrasound, nephrotic-range proteinuria, and rapidly progressing renal failure. This may occur at any stage of HIV but is most common as a late complication. Pre-ART studies show benefit from treatment with ACE inhibitors and possibly with corticosteroids; m
