Figure 720

Acyclovir nephrotoxicity. Drugs may induce acute renal failure by more than one mechanism. For instance, acute renal failure may complicate the use of acyclovir as a result of intrarenal precipitation of acyclovir crystals, acute interstitial nephritis, or acute tubular necrosis [139,144,153]. An example of nonoliguric acute tubular necrosis associated with administration of large doses of intravenous acyclovir is illustrated, which was readily reversible on decreasing the dose of acyclovir from 2.4 to 0.4 g/24 h. Patients infected with HIV can exhibit a broad spectrum of conditions that may affect the kidneys. Renal biopsy is useful for diagnostic and prognostic purposes when the cause of acute renal failure is not clinically evident. In a recent study of 60 patients with acute renal failure, a percutaneous renal biopsy yielded a pathologic diagnosis in 13% that was not expected clinically [154].

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