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Bering JL, Wiedmeier-Nutor JE, Sproat L, DiBaise JK. Bone marrow oxalosis with pancytopenia in a patient with short bowel syndrome: Report of a case and review of the literature. JPEN J Parenter Enteral Nutr 2023; 47:165-170. [PMID: 36181457 DOI: 10.1002/jpen.2453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/15/2022] [Accepted: 09/27/2022] [Indexed: 01/11/2023]
Abstract
Systemic oxalosis is a condition in which calcium oxalate crystals deposit into various bodily tissues. Although this may occur as the result of a rare primary syndrome in which an error of glyoxylate metabolism causes an overproduction of oxalate, it is more often seen as a secondary process characterized by increased enteric oxalate absorption. Here, we describe a patient with short bowel syndrome on long-term parenteral nutrition support who developed a unique manifestation of systemic oxalosis, leading to deposition of oxalate crystals within the bone marrow contributing to pancytopenia. In this report, in addition to reviewing the literature on this presumably rare manifestation of oxalosis, we also discuss its pathogenesis in the setting of short bowel syndrome and its management, including prevention.
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Affiliation(s)
- Jamie L Bering
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | | | - Lisa Sproat
- Division of Hematology and Oncology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - John K DiBaise
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
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2
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Wang L, Zhu Z, Li J. Case report: Acute oxalate nephropathy due to traditional medicinal herbs. Front Med (Lausanne) 2022; 9:1063681. [DOI: 10.3389/fmed.2022.1063681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022] Open
Abstract
Acute oxalate nephropathy (AON), defined as the association between acute kidney injury (AKI) and the deposition of oxalate crystals in the renal parenchyma, is a rare complication of hyperoxaluria. We report a rare case of AON in an adult due to medicinal herbs intake leading to crystal-induced AKI. We recommend that a thorough medication history including the use of medicinal herbs, should be obtained for all patients with a rapid loss of kidney function, especially in the absence of known risk factors for AKI. The use of medicinal herbs with unknown oxalate contents would increase the risk of AON and should be avoided.
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3
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Rudziński M, Ławiński M, Gradowski Ł, Antoniewicz AA, Słodkowski M, Bedyńska S, Kostro J, Singer P. Kidney stones are common in patients with short-bowel syndrome receiving long-term parenteral nutrition: A predictive model for urolithiasis. JPEN J Parenter Enteral Nutr 2022; 46:671-677. [PMID: 33938015 DOI: 10.1002/jpen.2133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND In short-bowel syndrome (SBS) treated with parenteral nutrition (PN), multiple complications can occur. The etiology of kidney stones may be linked to the underlying disease thrombosis, surgical complications, complications of therapy for cancer, Crohn's disease, metabolic abnormalities resulting from morphological and functional changes in the gastrointestinal tract, and to treatment used. We analyzed all these parameters in a large cohort of patients receiving home PN (HPN), to define the incidence of stones and groups of patients particularly at risk of stone formation. One of the objectiveswas to develop a predictive model of urolithiasis. METHODS This observational retrospective study included 459 patients with SBS recieving HPN in a single center. Patient records were evaluated for demographics, SBS etiology, and underlying disease, anatomy of the gastrointestinal tract, intestinal failure classification, nutrition regimen, and presence of urolithiasis. RESULTS Kidney stones were diagnosed in 24% of patients. Nodifferences in incidence were noted between the various etiologic groups. The incidence in patients with a colon in continuity and those with an end stoma was similar. The length of residual small bowel did not play a role in stone formation. There were no differences between patients according to the severity of intestinal failure. In patients treated with PN and limited oral feeding, the risk of urolithiasis was twice as high as in patients receiving PN only. CONCLUSIONS Patients developed urolithiasis with no relation to the SBS etiology. The risk of kidney stone formation was higher in patients recieving PN with oral feeding.
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Affiliation(s)
- Marcin Rudziński
- Department of Urology, Multidisciplinary Hospital Międzylesie, Warsaw, Poland
| | - Michał Ławiński
- Department of General Surgery, Gastroenterology and Oncology, Medical University of Warsaw, Warsaw, Poland
- Institute of Genetics and Animal Biotechnology Polish Academy of Sciences, Jastrzębiec, Poland
| | - Łukasz Gradowski
- SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Artur A Antoniewicz
- Department of Urology, Multidisciplinary Hospital Międzylesie, Warsaw, Poland
| | - Maciej Słodkowski
- Department of General Surgery, Gastroenterology and Oncology, Medical University of Warsaw, Warsaw, Poland
| | - Sylwia Bedyńska
- SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Justyna Kostro
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Tel Aviv University, Tel Aviv, Israel
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4
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Short Bowel Syndrome and Kidney Transplantation: Challenges, Outcomes, and the Use of Teduglutide. Case Rep Transplant 2020; 2020:8819345. [PMID: 33083084 PMCID: PMC7557916 DOI: 10.1155/2020/8819345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/18/2020] [Accepted: 09/18/2020] [Indexed: 11/19/2022] Open
Abstract
Among patients with short bowel syndrome who commonly have kidney disease, kidney transplantation remains challenging. We describe the clinicopathologic course of a 59-year old man with short bowel syndrome secondary to Crohn's disease who underwent a deceased donor kidney transplant that was complicated by recurrent acute kidney allograft injury due to volume depletion from diarrhea, ultimately requiring the placement of permanent intravenous access for daily volume expansion at home resulting in the recovery of allograft function. Teduglutide treatment at 1.8 years post-transplant led to a dramatic decrease in diarrhea. A literature review of similar cases yielded 18 patients who underwent 19 kidney transplants. Despite high rates of complications, at the time of last follow-up (median 2.1 years [0.04-7]), 94% of the patients were still alive and 89% had functioning allografts, with a median eGFR of 37.5 [14-122] ml/min/1.73m2. In conclusion, despite high rates of complications, kidney transplantation in patients with short bowel syndrome is associated with acceptable short- and midterm outcomes. Further, we report for the first time the effects of the glucagon-like peptide-2 analogue teduglutide for short bowel syndrome in a kidney transplant recipient.
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Lumlertgul N, Siribamrungwong M, Jaber BL, Susantitaphong P. Secondary Oxalate Nephropathy: A Systematic Review. Kidney Int Rep 2018; 3:1363-1372. [PMID: 30450463 PMCID: PMC6224620 DOI: 10.1016/j.ekir.2018.07.020] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/22/2018] [Accepted: 07/23/2018] [Indexed: 01/16/2023] Open
Abstract
Introduction Little is known of the clinical outcomes of secondary oxalate nephropathy. To inform clinical practice, we performed a systematic review of case reports and case series to examine the clinical characteristics and outcomes of patients with secondary oxalate nephropathy. Methods Electronic databases were searched for case reports and case series of individual cases or cohorts of patients with biopsy-proven oxalate nephropathy in native or transplanted kidneys from 1950 until January 2018. Results Fifty-seven case reports and 10 case series met the inclusion criteria, totaling 108 patients. The case series were meta-analyzed. Mean age was 56.4 years old, 59% were men, and 15% were kidney transplant recipients. Fat malabsorption (88%) was the most commonly attributed cause of oxalate nephropathy, followed by excessive dietary oxalate consumption (20%). The mean baseline serum creatinine was 1.3 mg/dl and peaked at 4.6 mg/dl. Proteinuria, hematuria, and urinary crystals was reported in 69%, 32%, and 26% of patients, respectively. Mean 24-hour urinary oxalate excretion was 85.4 mg/d. In addition to universal oxalate crystal deposition in tubules and/or interstitium, kidney biopsy findings included acute tubular injury (71%), tubular damage and atrophy (69%), and interstitial mononuclear cell infiltration (72%); 55% of patients required dialysis. None had complete recovery, 42% had partial recovery, and 58% remained dialysis-dependent. Thirty-three percent of patients died. Conclusion Secondary oxalate nephropathy is a rare but potentially devastating condition. Renal replacement therapy is required in >50% of patients, and most patients remain dialysis-dependent. Studies are needed for effective preventive and treatment strategies in high-risk patients with hyperoxaluria-enabling conditions.
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Affiliation(s)
- Nuttha Lumlertgul
- Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Monchai Siribamrungwong
- Department of Medicine, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Bertrand L. Jaber
- Department of Medicine, St. Elizabeth’s Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Paweena Susantitaphong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
- Correspondence: Paweena Susantitaphong, Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, 10330.
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6
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Chua CC, Lim H, Testro A, Hong FS. Passenger lymphocyte syndrome due to anti‐B and anti‐Jk
a
following combined intestinal and renal transplantation. ACTA ACUST UNITED AC 2018. [DOI: 10.1111/voxs.12435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- C. C. Chua
- Department of Laboratory Haematology Austin Health Melbourne VIC Australia
| | - H. Lim
- Department of Laboratory Haematology Austin Health Melbourne VIC Australia
| | - A. Testro
- Australian Intestinal Transplant Service Austin Health Melbourne VIC Australia
| | - F. S. Hong
- Department of Laboratory Haematology Austin Health Melbourne VIC Australia
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7
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Abstract
Background Enteric hyperoxaluria due to malabsorption may cause chronic oxalate nephropathy and lead to end-stage renal disease. Kidney transplantation is challenging given the risk of recurrent calcium-oxalate deposition and nephrolithiasis. Methods We established a protocol to reduce plasma oxalic acid levels peritransplantation based on reduced intake and increased removal of oxalate. The outcomes of 10 kidney transplantation patients using this protocol are reported. Results Five patients received a living donor kidney and had immediate graft function. Five received a deceased donor kidney and had immediate (n = 1) or delayed graft function (n = 4). In patients with delayed graft function, the protocol was prolonged after transplantation. In 3 patients, our protocol was reinstituted because of late complications affecting graft function. One patient with high-output stoma and relatively low oxalate levels had lost her first kidney transplant because of recurrent oxalate depositions but now receives intravenous fluid at home on a routine basis 3 times per week to prevent dehydration. Patients are currently between 3 and 32 months after transplantation and all have a stable estimated glomerular filtration rate (mean, 51 ± 21 mL/min per 1.73 m2). In 4 of 8 patients who underwent for cause biopsies after transplantation oxalate depositions were found. Conclusions This is the first systematic description of kidney transplantation in a cohort of patients with enteric hyperoxaluria. Common complications after kidney transplantation impact long-term transplant function in these patients. With our protocol, kidney transplantation outcomes were favorable in this population with unfavorable transplantation prospects and even previous unsuccessful transplants.
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8
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Choice of Allograft in Patients Requiring Intestinal Transplantation: A Critical Review. Can J Gastroenterol Hepatol 2017; 2017:1069726. [PMID: 28553630 PMCID: PMC5434314 DOI: 10.1155/2017/1069726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 04/05/2017] [Indexed: 02/06/2023] Open
Abstract
Intestinal transplantation (ITx) is indicated in patients with irreversible intestinal failure (IF) and life-threatening complications related to total parenteral nutrition (TPN). ITx can be classified into three main types. Isolated intestinal transplantation (IITx), that is, transplantation of the jejunoileum, is indicated in patients with preserved liver function. Combined liver-intestine transplantation (L-ITx), that is, transplantation of the liver and the jejunoileum, is indicated in patients with liver failure related to TPN. Thus, patients with cirrhosis or advanced fibrosis should receive a combined allograft, while patients with lower grades of liver fibrosis can usually safely undergo ITx. Reflecting their degree of sickness, the waitlist mortality rate and the early posttransplant outcomes of patients receiving L-ITx are worse than IITx. However, L-ITx is associated with better long-term graft and patient survival. Multivisceral transplantation (MVTx), that is, transplantation of the organs dependent on the celiac axis and superior mesenteric artery, can be classified into full MVTx if it includes the liver and modified MVTx if it does not. The most common indications for MVTx are extensive portomesenteric thrombosis and diffuse gastrointestinal pathology such as motility disorders and polyposis syndrome. Every patient with IF should undergo a multidisciplinary evaluation by an experienced ITx team.
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9
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Ceulemans LJ, Braza F, Monbaliu D, Jochmans I, De Hertogh G, Du Plessis J, Emonds MP, Kitade H, Kawai M, Li Y, Zhao X, Koshiba T, Sprangers B, Brouard S, Waer M, Pirenne J. The Leuven Immunomodulatory Protocol Promotes T-Regulatory Cells and Substantially Prolongs Survival After First Intestinal Transplantation. Am J Transplant 2016; 16:2973-2985. [PMID: 27037650 DOI: 10.1111/ajt.13815] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 03/20/2016] [Accepted: 03/29/2016] [Indexed: 01/25/2023]
Abstract
Intestinal transplantation (ITx) remains challenged by frequent/severe rejections and immunosuppression-related complications (infections/malignancies/drug toxicity). We developed the Leuven Immunomodulatory Protocol (LIP) in the lab and translated it to the clinics. LIP consists of experimentally proven maneuvers, destined to promote T-regulatory (Tregs)-dependent graft-protective mechanisms: donor-specific blood transfusion (DSBT); avoiding high-dose steroids/calcineurin-inhibitors; and minimizing reperfusion injury and endotoxin translocation. LIP was tested in 13 consecutive ITx from deceased donors (2000-2014) (observational cohort study). Recipient age was 37 years (2.8-57 years). Five-year graft/patient survival was 92%. One patient died at 9 months due to aspergillosis, another at 12 years due to nonsteroidal anti-inflammatory drug-induced enteropathy. Early acute rejection (AR) developed in two (15%); late AR in three (23%); all were reversible. No chronic rejection (CR) occurred. No malignancies developed and estimated glomerular filtration rate remained stable post-Tx. At last follow-up (3.5 years [0.5-12.5 years]), no donor-specific antibodies were detected and 11 survivors were total parenteral nutrition free with a Karnofsky score >90% in 8 recipients (follow-up >1 years). A high frequency of circulating CD4+ CD45RA- Foxp3hi memory Tregs was found (1.8% [1.39-2.21]), comparable to tolerant kidney transplant (KTx) recipients and superior to stable immunosuppression (IS)-KTx, KTx with CR, and healthy volunteers. In this ITx cohort we show that DSBT in a low-inflammatory/pro-regulatory environment activates Tregs at levels similar to tolerant-KTx, without causing sensitization. LIP limits rejection under reduced IS and thereby prolongs long-term survival to an extent not previously attained after ITx.
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Affiliation(s)
- L J Ceulemans
- Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, and Department of Microbiology and Immunology, University of Leuven, KU Leuven, Leuven, Belgium
| | - F Braza
- Institut de Recherche en Transplantation, Urologie et Néphrologie du Centre Hospitalier Universitaire Hôtel Dieu, University of Nantes, Nantes, France
| | - D Monbaliu
- Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, and Department of Microbiology and Immunology, University of Leuven, KU Leuven, Leuven, Belgium
| | - I Jochmans
- Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, and Department of Microbiology and Immunology, University of Leuven, KU Leuven, Leuven, Belgium
| | - G De Hertogh
- Translational Cell and Tissue Research, University Hospitals Leuven, and Department of Imaging and Pathology, University of Leuven, KU Leuven, Leuven, Belgium
| | - J Du Plessis
- Division of Hepatology, University Hospitals Leuven, and Department of Clinical and Experimental Medicine, University of Leuven, KU Leuven, Leuven, Belgium
| | - M-P Emonds
- Laboratory for Histocompatibility and Immunogenetics (HILA), Red Cross Flanders, Mechelen, Belgium.,Experimental Transplantation, University Hospitals Leuven, and Department of Microbiology and Immunology, University of Leuven, KU Leuven, Leuven, Belgium
| | - H Kitade
- Experimental Transplantation, University Hospitals Leuven, and Department of Microbiology and Immunology, University of Leuven, KU Leuven, Leuven, Belgium
| | - M Kawai
- Experimental Transplantation, University Hospitals Leuven, and Department of Microbiology and Immunology, University of Leuven, KU Leuven, Leuven, Belgium
| | - Y Li
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - X Zhao
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - T Koshiba
- Experimental Transplantation, University Hospitals Leuven, and Department of Microbiology and Immunology, University of Leuven, KU Leuven, Leuven, Belgium.,Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - B Sprangers
- Experimental Transplantation, University Hospitals Leuven, and Department of Microbiology and Immunology, University of Leuven, KU Leuven, Leuven, Belgium
| | - S Brouard
- Institut de Recherche en Transplantation, Urologie et Néphrologie du Centre Hospitalier Universitaire Hôtel Dieu, University of Nantes, Nantes, France
| | - M Waer
- Experimental Transplantation, University Hospitals Leuven, and Department of Microbiology and Immunology, University of Leuven, KU Leuven, Leuven, Belgium
| | - J Pirenne
- Abdominal Transplant Surgery & Transplant Coordination, University Hospitals Leuven, and Department of Microbiology and Immunology, University of Leuven, KU Leuven, Leuven, Belgium
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10
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Asplin JR. The management of patients with enteric hyperoxaluria. Urolithiasis 2015; 44:33-43. [PMID: 26645872 DOI: 10.1007/s00240-015-0846-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/05/2015] [Indexed: 01/01/2023]
Abstract
Enteric hyperoxaluria is a common occurrence in the setting of fat malabsorption, usually due to intestinal resection or intestinal bypass surgery. Enhanced intestinal absorption of dietary oxalate leads to elevated renal oxalate excretion, frequently in excess of 100 mg/d (1.14 mmol/d). Patients are at increased risk of urolithiasis and loss of kidney function from oxalate nephropathy. Fat malabsorption causes increased binding of diet calcium by free fatty acids, reducing the calcium available to precipitate diet oxalate. Delivery of unabsorbed bile salts and fatty acids to the colon increases colonic permeability, the site of oxalate hyper-absorption in enteric hyperoxaluria. The combination of soluble oxalate in the intestinal lumen and increased permeability of the colonic mucosa leads to hyperoxaluria. Dietary therapy consists of limiting oxalate and fat intake. The primary medical intervention is the use of oral oxalate binding agents such as calcium salts to reduce free intestinal oxalate levels. Bile acid sequestrants can be useful in patients with ileal resection and bile acid malabsorption. Oxalate degrading bacteria provided as probiotics are being investigated but as of yet, no definite benefit has been shown with currently available preparations. The current state of medical therapy and potential future directions will be summarized in this article.
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Affiliation(s)
- John R Asplin
- Litholink® Corporation, Laboratory Corporation of America® Holdings, 2250 W Campbell Park Dr., Chicago, IL, 60612, USA.
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11
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Ceulemans LJ, Monbaliu D, De Roover A, Detry O, Troisi RI, Rogiers X, Reding R, Lerut JP, Ysebaert D, Chapelle T, Pirenne J. Belgian multicenter experience with intestinal transplantation. Transpl Int 2015; 28:1362-70. [DOI: 10.1111/tri.12615] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 02/03/2015] [Accepted: 05/27/2015] [Indexed: 12/22/2022]
Affiliation(s)
- Laurens J. Ceulemans
- Abdominal Transplant Surgery; University Hospitals Leuven; Leuven Belgium
- Department of Microbiology and Immunology; KU Leuven; Leuven Belgium
| | - Diethard Monbaliu
- Abdominal Transplant Surgery; University Hospitals Leuven; Leuven Belgium
- Department of Microbiology and Immunology; KU Leuven; Leuven Belgium
| | - Arnaud De Roover
- Department of Abdominal Surgery and Transplantation; University Hospital of Liège; Liège Belgium
| | - Olivier Detry
- Department of Abdominal Surgery and Transplantation; University Hospital of Liège; Liège Belgium
| | - Roberto I. Troisi
- Department of General and Hepatobiliary Surgery; Liver Transplantation Service; Ghent University Hospital; Ghent Belgium
| | - Xavier Rogiers
- Department of General and Hepatobiliary Surgery; Liver Transplantation Service; Ghent University Hospital; Ghent Belgium
| | - Raymond Reding
- Department of Abdominal Surgery and Transplantation; University Hospitals Saint Luc - UCL; Brussels Belgium
| | - Jan P. Lerut
- Department of Abdominal Surgery and Transplantation; University Hospitals Saint Luc - UCL; Brussels Belgium
| | - Dirk Ysebaert
- Department of Hepatobiliary and Transplantation Surgery; Antwerp University Hospital; Antwerp Belgium
| | - Thierry Chapelle
- Department of Hepatobiliary and Transplantation Surgery; Antwerp University Hospital; Antwerp Belgium
| | - Jacques Pirenne
- Abdominal Transplant Surgery; University Hospitals Leuven; Leuven Belgium
- Department of Microbiology and Immunology; KU Leuven; Leuven Belgium
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12
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Bhasin B, Ürekli HM, Atta MG. Primary and secondary hyperoxaluria: Understanding the enigma. World J Nephrol 2015; 4:235-244. [PMID: 25949937 PMCID: PMC4419133 DOI: 10.5527/wjn.v4.i2.235] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 08/29/2014] [Accepted: 02/09/2015] [Indexed: 02/05/2023] Open
Abstract
Hyperoxaluria is characterized by an increased urinary excretion of oxalate. Primary and secondary hyperoxaluria are two distinct clinical expressions of hyperoxaluria. Primary hyperoxaluria is an inherited error of metabolism due to defective enzyme activity. In contrast, secondary hyperoxaluria is caused by increased dietary ingestion of oxalate, precursors of oxalate or alteration in intestinal microflora. The disease spectrum extends from recurrent kidney stones, nephrocalcinosis and urinary tract infections to chronic kidney disease and end stage renal disease. When calcium oxalate burden exceeds the renal excretory ability, calcium oxalate starts to deposit in various organ systems in a process called systemic oxalosis. Increased urinary oxalate levels help to make the diagnosis while plasma oxalate levels are likely to be more accurate when patients develop chronic kidney disease. Definitive diagnosis of primary hyperoxaluria is achieved by genetic studies and if genetic studies prove inconclusive, liver biopsy is undertaken to establish diagnosis. Diagnostic clues pointing towards secondary hyperoxaluria are a supportive dietary history and tests to detect increased intestinal absorption of oxalate. Conservative treatment for both types of hyperoxaluria includes vigorous hydration and crystallization inhibitors to decrease calcium oxalate precipitation. Pyridoxine is also found to be helpful in approximately 30% patients with primary hyperoxaluria type 1. Liver-kidney and isolated kidney transplantation are the treatment of choice in primary hyperoxaluria type 1 and type 2 respectively. Data is scarce on role of transplantation in primary hyperoxaluria type 3 where there are no reports of end stage renal disease so far. There are ongoing investigations into newer modalities of diagnosis and treatment of hyperoxaluria. Clinical differentiation between primary and secondary hyperoxaluria and further between the types of primary hyperoxaluria is very important because of implications in treatment and diagnosis. Hyperoxaluria continues to be a challenging disease and a high index of clinical suspicion is often the first step on the path to accurate diagnosis and management.
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13
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Nazzal L, Puri S, Goldfarb DS. Enteric hyperoxaluria: an important cause of end-stage kidney disease. Nephrol Dial Transplant 2015; 31:375-82. [PMID: 25701816 DOI: 10.1093/ndt/gfv005] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 12/21/2014] [Indexed: 12/11/2022] Open
Abstract
Hyperoxaluria is a frequent complication of inflammatory bowel diseases, ileal resection and Roux-en-Y gastric bypass and is well-known to cause nephrolithiasis and nephrocalcinosis. The associated prevalence of chronic kidney disease and end-stage kidney disease (ESKD) is less clear but may be more consequential than recognized. In this review, we highlight three cases of ESKD due to enteric hyperoxaluria following small bowel resections. We review current information on the pathophysiology, complications and treatment of this complex disease.
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Affiliation(s)
- Lama Nazzal
- Nephrology Section, New York Harbor VA Healthcare System and Nephrology Division, NYU Langone Medical Center, New York, NY, USA
| | - Sonika Puri
- Nephrology Section, New York Harbor VA Healthcare System and Nephrology Division, NYU Langone Medical Center, New York, NY, USA
| | - David S Goldfarb
- Nephrology Section, New York Harbor VA Healthcare System and Nephrology Division, NYU Langone Medical Center, New York, NY, USA
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14
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Karaolanis G, Lionaki S, Moris D, Palla VV, Vernadakis S. Secondary hyperoxaluria: a risk factor for kidney stone formation and renal failure in native kidneys and renal grafts. Transplant Rev (Orlando) 2014; 28:182-7. [PMID: 24999029 DOI: 10.1016/j.trre.2014.05.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 05/18/2014] [Accepted: 05/21/2014] [Indexed: 12/22/2022]
Abstract
Secondary hyperoxaluria is a multifactorial disease affecting several organs and tissues, among which stand native and transplanted kidneys. Nephrocalcinosis and nephrolithiasis may lead to renal insufficiency. Patients suffering from secondary hyperoxaluria, should be promptly identified and appropriately treated, so that less renal damage occurs. The aim of this review is to underline the causes of hyperoxaluria and the related pathophysiologic mechanisms, which are involved, along with the description of seven cases of irreversible renal graft injury due to secondary hyperoxaluria.
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Affiliation(s)
- Georgios Karaolanis
- Transplantation Unit, Laiko General Hospital, Medical School of Athens, Athens, Greece.
| | - Sophia Lionaki
- Nephrology and Transplantation Unit, Laiko Hospital, Athens, Greece
| | - Demetrios Moris
- Transplantation Unit, Laiko General Hospital, Medical School of Athens, Athens, Greece
| | | | - Spiridon Vernadakis
- Transplantation Unit, Laiko General Hospital, Medical School of Athens, Athens, Greece
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Waghray A, Nassar A, Hashimoto K, Eghtesad B, Aucejo F, Krishnamurthi V, Uso TD, Srinivas T, Steiger E, Abu-Elmagd K, Quintini C. Combined intestine and kidney transplantation in a patient with encapsulating peritoneal sclerosis: case report. Am J Transplant 2013; 13:3274-7. [PMID: 24266976 DOI: 10.1111/ajt.12505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 09/05/2013] [Accepted: 09/06/2013] [Indexed: 01/25/2023]
Abstract
Encapsulating peritoneal sclerosis (EPS) is a rare but devastating complication of peritoneal dialysis characterized by fibrosis and calcification of the intestine that, in severe cases, can progress to intestinal failure and total parenteral nutrition dependency. Medical and surgical interventions carry a poor prognosis in these patients. We describe a case of a 36-year-old female with end-stage kidney disease and severe EPS not amenable to surgical intervention who underwent a combined intestinal and kidney transplantation. At 3 years posttransplantation, the patient has normal intestinal and kidney function. This represents, to our knowledge, the first report of severe EPS and end-stage kidney disease treated with a combined transplant.
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Affiliation(s)
- A Waghray
- Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH
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