What is the mechanism of renal injury associated with aciclovir?

The mechanism of renal injury associated with aciclovir primarily involves crystalluria. Aciclovir, an antiviral medication used to treat infections caused by certain types of viruses, can precipitate in renal tubules when the urine is concentrated or has low volume, leading to the formation of crystals. This crystallization occurs because aciclovir is poorly soluble in urine, especially at higher doses or when hydration is inadequate.

When aciclovir crystallizes, it can obstruct the normal flow of urine, leading to renal injury and potential acute kidney injury due to the blockage of renal tubules. This is especially a concern in patients who are not well-hydrated or have underlying renal impairment. Maintaining adequate hydration and monitoring renal function is essential when administering aciclovir to minimize the risk of crystalluria and subsequent kidney damage.

Understanding this mechanism highlights the importance of hydration and careful monitoring in patients receiving aciclovir to prevent renal complications.