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Efavirenz-induced urolithiasis

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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.

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References

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Authors and Affiliations

  1. Division of Urology, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland

    G. J. Wirth & C. E. Iselin

  2. Central Laboratory of Clinical Chemistry, University Hospital of Geneva, Geneva, Switzerland

    J. Teuscher & J. D. Graf

Authors
  1. G. J. Wirth
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  2. J. Teuscher
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  3. J. D. Graf
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  4. C. E. Iselin
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Correspondence to G. J. Wirth.

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Wirth, G.J., Teuscher, J., Graf, J.D. et al. Efavirenz-induced urolithiasis. Urol Res 34, 288–289 (2006). https://doi.org/10.1007/s00240-006-0052-6

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  • DOI: https://doi.org/10.1007/s00240-006-0052-6

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