ritonavir and Acute-Kidney-Injury

The COVID-19 pandemic created a worldwide debilitating health crisis with the entire humanity suffering from the deleterious effects associated with the high infectivity and mortality rates. While significant evidence is currently available online and targets various aspects of the disease, both inflammatory and noninflammatory kidney manifestations secondary to COVID-19 infection are still largely underrepresented. In this review, we summarized current knowledge about COVID-19-related kidney manifestations, their pathologic mechanisms as well as various pharmacotherapies used to treat patients with COVID-19. We also shed light on the effect of these medications on kidney functions that can further enhance renal damage secondary to the illness.

Topics: Acute Kidney Injury; Aldosterone; Angiotensins; Antibodies, Monoclonal, Humanized; Autopsy; Biopsy; COVID-19; COVID-19 Drug Treatment; COVID-19 Vaccines; Dexamethasone; Enoxaparin; Heparin; Heparin, Low-Molecular-Weight; Humans; Inflammation; Interleukin 1 Receptor Antagonist Protein; Kidney; Kidney Diseases; Kidney Transplantation; Lopinavir; Pandemics; Renal Replacement Therapy; Renin-Angiotensin System; Ritonavir; SARS-CoV-2

Ritonavir therapy is not generally considered nephrotoxic. We report a case of acute kidney injury secondary to ritonavir, with kidney biopsy demonstrating extensive acute tubular injury. This is the first report of a kidney biopsy and pathology in acute kidney injury associated with ritonavir. A review of published medical literature on the topic is also presented.

Topics: Acute Kidney Injury; Antiretroviral Therapy, Highly Active; Biomarkers; Biopsy; Creatinine; Drug Substitution; HIV Infections; HIV Protease Inhibitors; Humans; Kidney; Kidney Tubules; Male; Middle Aged; Ritonavir; Time Factors

Topics: Acute Kidney Injury; Antiviral Agents; Cytochrome P-450 CYP3A; Edema; Humans; Nifedipine; Oliguria; Ritonavir

An outbreak of coronavirus disease-19 (COVID-19) has occurred in different parts of the world. Although a large piece of information regarding the epidemiology, clinical features, and management of COVID-19 has been reported in the general population, there is very limited data regarding organ transplant recipients, particularly regarding the management of maintenance immunosuppressive agents during infection.. We described a case of kidney transplant recipient from Thailand who had COVID-19 pneumonia and severe acute kidney injury.. The patient's serum creatinine peaked at 7.0 mg/dL on day 15 of illness and returned to baseline value of 2.0 mg/dL on day 26 of illness. We have shown how we modified tacrolimus, mycophenolate, and steroids in the patient who had received favipiravir and lopinavir/ritonavir for COVID-19 pneumonia.. In this case, successful modification of this immunosuppressive regimen was accomplished to reduce drug interaction complications, aiming to avoid calcineurin inhibitor nephrotoxicity while maintaining appropriate levels of immunosuppression to prevent organ rejection and to promote the patient's recovery from infection.

Topics: Acute Kidney Injury; Adult; Amides; COVID-19 Drug Treatment; Drug Combinations; Drug Interactions; Humans; Immunosuppressive Agents; Kidney Transplantation; Lopinavir; Male; Mycophenolic Acid; Pyrazines; Ritonavir; Steroids; Tacrolimus; Thailand; Transplant Recipients

Pregnancy seems to increase the risk of thrombotic thrombocytopenic purpura (TTP) relapses and make the TTP more severe in any of the pregnancy trimesters, or even during the postpartum period.. This study highlights details of treating a COVID-19 pregnant patient who survived. This 21-year addicted White woman was admitted at her 29th week and delivered a stillbirth. She was transferred to another hospital after showing signs of TTP, which was caused by a viral infection.. This viral infection caused fever and dyspnea, and the patient was tested positive for COVID-19 infection. A chest computed tomography scan showed diffuse multiple bilateral consolidations and interlobar septal thickening. She stayed at the Intensive Care Unit for 20 days and treated with plasmapheresis. As far as we know, this is the first report of a TTP pregnant patient with COVID-19 infection.

Topics: Acute Kidney Injury; Amphetamine-Related Disorders; Antiviral Agents; COVID-19; Drug Combinations; Erythrocyte Transfusion; Female; Hemoglobins; Humans; Hydroxychloroquine; Intensive Care Units; L-Lactate Dehydrogenase; Lopinavir; Methamphetamine; Plasmapheresis; Pregnancy; Pregnancy Complications, Hematologic; Pregnancy Complications, Infectious; Purpura, Thrombotic Thrombocytopenic; Renal Dialysis; Ritonavir; SARS-CoV-2; Stillbirth; Tomography, X-Ray Computed; Young Adult

In late December 2019, an outbreak of a novel coronavirus which caused coronavirus disease 2019 (COVID-19) was initiated. Acute kidney injury (AKI) was associated with higher severity and mortality of COVID-19. We aimed to evaluate the effects of comorbidities and medications in addition to determining the association between AKI, antibiotics against coinfections (AAC) and outcomes of patients. We conducted a retrospective study on adult patients hospitalized with COVID-19 in a tertiary center. Our primary outcomes were the incidence rate of AKI based on comorbidities and medications. The secondary outcome was to determine mortality, intensive care unit (ICU) admission, and prolonged hospitalization by AKI and AAC. Univariable and multivariable logistic regression method was used to explore predictive effects of AKI and AAC on outcomes. Out of 854 included participants, 118 patients developed AKI in whom, 57 used AAC and 61 did not. Hypertension and diabetes were the most common comorbidities in patients developed AKI. AAC, lopinavir/ritonavir, ribavirin, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, and corticosteroids had significant higher rate of administration in patients developed AKI. AAC were associated with higher deaths (odds ratio [OR] = 5.13; 95% confidence interval (CI): 3-8.78) and ICU admission (OR = 5.87; 95%CI: 2.81-12.27), while AKI had higher OR for prolonged hospitalization (3.37; 95%CI: 1.76-6.45). Both AKI and AAC are associated with poor prognosis of COVID-19. Defining strict criteria regarding indications and types of antibiotics would help overcoming concomitant infections and minimizing related adverse events.

Topics: Acute Kidney Injury; Adult; Angiotensin-Converting Enzyme Inhibitors; Antiviral Agents; Azithromycin; Coinfection; COVID-19; COVID-19 Drug Treatment; Critical Care; Drug Combinations; Female; Hospital Mortality; Hospitalization; Humans; Iran; Linezolid; Lopinavir; Male; Middle Aged; Retrospective Studies; Ribavirin; Ritonavir; SARS-CoV-2; Treatment Outcome; Vancomycin

Topics: Acute Kidney Injury; Adult; Antiviral Agents; Betacoronavirus; Clinical Laboratory Techniques; Coronavirus Infections; COVID-19; COVID-19 Testing; Darunavir; Drug Interactions; Drug Monitoring; Humans; Hydroxychloroquine; Immunosuppressive Agents; Liver Transplantation; Male; Pandemics; Pneumonia, Viral; Prednisone; Risk Adjustment; Ritonavir; SARS-CoV-2; Tacrolimus; Transplant Recipients; Treatment Outcome

Kidney injury (defined as the presence of albuminuria, proteinuria, glycosuria [without hyperglycemia], hematuria, and/or renal hypophosphatemia) is an emerging problem in human immunodeficiency virus (HIV)-infected patients, although few data are available on the role of protease inhibitors (PIs) in this condition.To determine the time to kidney injury in a cohort of HIV-infected patients receiving a PI-containing regimen.We report the results of a subanalysis of a published cross-sectional study. The subanalysis included only patients receiving PI-containing regimens for more than 6 months (377 of the overall 970 patients). We determined associated factors and constructed receiver operating characteristic curves to estimate time to kidney injury depending on the PI used.The percentage of patients with kidney injury was 27.7% for darunavir, 27.9% for lopinavir, and 30% for atazanavir. Time to kidney injury was as follows: 229 days for atazanavir/ritonavir (area under the curve [AUC], 0.639; sensitivity, 0.89; specificity, 0.41); 332 days for atazanavir/ritonavir plus tenofovir (AUC, 0.603; sensitivity, 0.75; and specificity, 0.29); 318 days for nonboosted atazanavir (AUC, 0.581; sensitivity, 0.89; and specificity, 0.29); 478 days for lopinavir/ritonavir (AUC, 0.566; sensitivity, 0.864; and specificity, 0.44); 1339 days for lopinavir/ritonavir plus tenofovir (AUC, 0.667; sensitivity, 0.86; and specificity, 0.77); 283 days for darunavir/ritonavir (AUC, 0.523; sensitivity, 0.80; and specificity, 0.261); and 286 days for darunavir/ritonavir plus tenofovir (AUC, 0.446; sensitivity, 0.789; and specificity, 0.245). The use of lopinavir/ritonavir without tenofovir was a protective factor (odds ratio = 1.772; 95%CI, 1.070-2.93; P = 0.026).For all PIs, the percentage of patients with kidney injury exceeded 27%, irrespective of tenofovir use. The longest time to kidney injury was recorded with lopinavir/ritonavir. These results demonstrate the need for renal monitoring, including urine samples, in patients receiving a PI-based regimen, even when tenofovir is not used concomitantly.

Topics: Acute Kidney Injury; Adult; Albuminuria; Antiretroviral Therapy, Highly Active; Atazanavir Sulfate; Biomarkers; Cross-Sectional Studies; Darunavir; Female; HIV Infections; HIV Protease Inhibitors; Humans; Lopinavir; Male; Middle Aged; Proteinuria; Ritonavir

Topics: Acute Kidney Injury; Adenine; Aged, 80 and over; Anti-HIV Agents; Biopsy; CD4 Lymphocyte Count; Diagnosis, Differential; Diarrhea; HIV Infections; Humans; Hypertension; Immunologic Tests; Kidney; Kidney Function Tests; Male; Monitoring, Physiologic; Organophosphonates; Ritonavir; Tenofovir; Treatment Outcome; Viral Load; Withholding Treatment

An HIV-infected asymptomatic woman developed acute kidney injury six weeks after initiation of combination antiretroviral therapy (cART). A renal biopsy revealed both renal-limited sarcoidosis and HIV nephropathy. The acute renal injury reversed with glucocorticoid therapy.

Topics: Acute Kidney Injury; Adenine; Adult; AIDS-Associated Nephropathy; Anti-Retroviral Agents; Atazanavir Sulfate; Female; HIV Infections; Humans; Oligopeptides; Organophosphonates; Prednisone; Pyridines; Ritonavir; Sarcoidosis; Tenofovir; Young Adult

Topics: Acute Kidney Injury; Anti-HIV Agents; Drug Interactions; HIV Infections; Humans; Hypertension; Lopinavir; Male; Middle Aged; Nifedipine; Pyrimidinones; Ritonavir

We report on a Subsaharian patient with HIV infection and disseminated tuberculosis who developed acute, severe hypersensitivity reaction to efavirenz including acute renal failure in addition to liver and lung involvement, in the absence of skin changes or blood eosinophilia.

Topics: Acute Kidney Injury; Adenine; Adult; Alkynes; Anti-HIV Agents; Benzoxazines; Cyclopropanes; Drug Hypersensitivity; Ghana; HIV; HIV Infections; HIV Protease Inhibitors; Humans; Lamivudine; Male; Mycobacterium tuberculosis; Organophosphonates; Reverse Transcriptase Inhibitors; Ritonavir; Tenofovir; Tuberculosis

Topics: Acquired Immunodeficiency Syndrome; Acute Kidney Injury; Adult; Alcoholism; Chemical and Drug Induced Liver Injury; Hepatitis C, Chronic; HIV Protease Inhibitors; Humans; Indinavir; Male; Rhabdomyolysis; Ritonavir

A RECOGNIZED COMPLICATION: 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.

Topics: Acute Kidney Injury; Adult; Anti-HIV Agents; Drug Therapy, Combination; HIV Protease Inhibitors; Humans; Kidney; Male; Middle Aged; Risk Factors; Ritonavir; Saquinavir

Topics: Acute Kidney Injury; Adult; HIV Infections; HIV Protease Inhibitors; Humans; Kidney Failure, Chronic; Male; Ritonavir

Topics: Acute Kidney Injury; Adult; Antiviral Agents; HIV Protease Inhibitors; Humans; Male; Middle Aged; Ritonavir; Thiazoles; Valine