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Atazanavir crystal-induced chronic granulomatous interstitial nephritis: case report A 51-year-old man developed atazanavir crystal-induced chronic granulomatous interstitial nephritis following treatment with atazanavir/ritonavir for HIV infection. The man, who had HIV infection, presented with worsening kidney function. Anamnesis revealed that he had been diagnosed with HIV at the age of 46 years after developing a varicella-zoster infection. He had started receiving atazanavir/ritonavir 3.5 years* prior to development of worsening kidney function [route and dosage not stated]. One month prior to current presentation, his serum creatinine level was found to be elevated. Upon current presentation, he was receiving atazanavir/ritonavir, lamivudine/ abacavir, gabapentin, pregabalin, capsaicin, hydrocodone/paracetamol, ferrous sulfate, hydroxyzine and unspecified multivitamins. Physical examination was noted to be unremarkable. Renal ultrasound revealed a right kidney of 10.4cm and left kidney of 11.0cm. Both kidneys were noted to have regular contour, preserved parenchymal echogenicity, no cysts, no masses, no stones, and no hydronephrosis. Urine culture was negative. However, he experienced sterile pyuria. The man was empirically treated with levofloxacin. Three weeks later, his serum creatinine level increased further. Due to unexplained progressive loss of kidney function, a percutaneous kidney biopsy was performed. The kidney biopsy specimen revealed up to 15 glomeruli present per level of section, of which 9 were globally sclerotic and 3 were segmentally sclerotic. Severe interstitial mononuclear infiltrate with numerous eosinophils and fibrosis was also observed. There was a granulomatous process with central necrosis and neutrophils with crystal-like material within the granulomas. He was diagnosed with atazanavir crystalinduced granulomatous interstitial nephritis and secondary glomerulosclerosis. Ritonavir was also considered to have contributed in the development of granulomatous interstitial nephritis. Atazanavir/ritonavir was switched to raltegravir. He continued receiving lamivudine/abacavir. He was also treated with unspecified corticosteroids which were subsequently tapered down. Within 8 months, his serum creatinine level improved. Partial recovery of kidney function was noted. * In the case presentation section of the article, the time interval between atazanavir/ritonavir initiation and development of renal symptoms has been stated as 3 years. However, in the discussion section of the article, the time interval has been stated as 3.5 years. For this case report, the first interval has been considered as 3.5 years. Varghese V, et al. Atazanavir Crystal-Induced Chronic Granulomatous Interstitial Nephritis. Kidney International Reports 5: 1106-1110, No. 7, Jul 2020. Available from: 803500083 URL: http://doi.org/10.1016/j.ekir.2020.04.007

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Reactions 5 Sep 2020 No. 1820