What is it about?
A 76-year-old woman with herpes simplex virus type 1 encephalitis, being treated with intravenous acyclovir, developed oliguric acute kidney injury that did not respond to hydration. Macroscopic crystals were observed in the urine collector and further examination of the urine sediment indicated acyclovir crystalluria. Continuous venovenous hemofiltration was initiated, given her neurological state and concern about acyclovir neurotoxicity.
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Why is it important?
Macroscopic urinary alterations are rare in acyclovir crystalluria, but are of clinical importance because they can be used to expedite the diagnosis. Drug dosing in recovering AKI is a challenge that can be improved by measuring dynamic parameters such as urinary creatinine clearance and therapeutic drug monitoring. Continuous venovenous hemofiltration is a successful alternative for acyclovir clearance in patients not suitable for intermittent hemodialysis.
Perspectives
Several factors may have contributed to the development of the crystallopathy and the AKI. - Hydration - Infusion velocity - Acyclovir dose
Ellen Vandendael
Associatie KU Leuven
Read the Original
This page is a summary of: AKI in a patient treated for herpes simplex virus encephalitis, Kidney360, June 2023, Wolters Kluwer Health,
DOI: 10.34067/kid.0000000000000181.
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