Efavirenz-induced urolithiasis.

Urological Research
G J WirthC E Iselin

Abstract

We describe the first case of efavirenz-induced urolithiasis in a 47-year-old HIV-positive patient. Urinary obstruction led to pyelonephritis and septic shock, requiring emergency ureteral catheterisation. The subsequent clinical course was favourable, allowing the patient's discharge on day 5. A 7 mm, radio-translucent, non-crystalline, beige stone was extracted during catheterisation. Stone analysis by Fourier transform infrared spectrometry, liquid chromatography and mass spectrometry revealed a stone composed of efavirenz (EFV) metabolites M4, M5, M8 (as described by Mutlib et al. in 1999) and approximately 50% of unspecified proteins. EFV is a non-nucleoside reverse transcriptase inhibitor introduced to European markets in 1999. It is principally metabolised by cytochrome P450 3A4 and 2B6. Of the dose, 14-34% is excreted in the urine, 1% as unchanged drug. The patient had been taking 600 mg EFV per day for 3 years. As EFV-induced urolithiasis has not been reported so far, we would like to draw the attention of the medical community to this potentially severe complication.

Citations

Aug 28, 2007·AIDS·Hassane IzzedineChristine Katlama
Apr 9, 2015·Clinical Kidney Journal·Hassane IzzedineFabrice Bonnet
Feb 22, 2016·The American Journal of the Medical Sciences·Chebel KhalilDaoud Abu-Hamdan
Jan 22, 2011·Expert Opinion on Pharmacotherapy·Zygimantas C AlsauskasMichael J Ross
Jul 11, 2008·Expert Opinion on Drug Safety·Marianne Harris
Dec 17, 2009·Advances in Chronic Kidney Disease·Jennifer Jao, Christina M Wyatt
Sep 7, 2007·Mayo Clinic Proceedings·Thushan I de SilvaDavid H Dockrell
Nov 18, 2008·Seminars in Nephrology·Mohamed G AttaGregory M Lucas
Aug 2, 2012·HIV Clinical Trials·Leonardo Calza
Dec 5, 2016·Urolithiasis·Neil S MandelAnn M Kolbach-Mandel
Aug 19, 2007·Drug Safety : an International Journal of Medical Toxicology and Drug Experience·Manfred Hauben, Jeffrey K Aronson

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