Acyclovir crystalluria: The utility of bedside urine routine microscopic examination

Abstract

Acyclovir, an acyclic nucleoside, is commonly used for the treatment of viral infections. Acyclovir is well tolerated in children. However, severe nephrotoxicity has been shown to occur in some children. One of the mechanisms for acyclovir-induced nephrotoxicity is acyclovir-induced crystalluria. Prompt attention to urine microscopy examination can help avoid drug-induced nephrotoxicity. Here, we report a case of a seven-year-old febrile comatose child who received intravenous empirical acyclovir therapy and developed cloudy urine. Bedside urine microscopic examination shows fine-needle-shaped crystal. The urine was cleared within 12 h of stopping the acyclovir and adequate intravascular hydration. A child recovered without evidence of acute kidney injury.

Keywords

• acyclovir
• children
• complications
• crystalluria
• microscopy
• urine examination