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Post Hospers G, Visser WJ, Verhoeven JGHP, Laging M, Baart SJ, Mertens zur Borg IRAM, Hesselink DA, de Mik-van Egmond AME, Betjes MGH, van Agteren M, Severs D, van de Wetering J, Zietse R, Vos MJ, Kema IP, Kho MML, Reinders MEJ, Roodnat JI. Delayed Graft Function After Kidney Transplantation: The Role of Residual Diuresis and Waste Products, as Oxalic Acid and Its Precursors. Transpl Int 2024; 37:13218. [PMID: 39100754 PMCID: PMC11294083 DOI: 10.3389/ti.2024.13218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 07/01/2024] [Indexed: 08/06/2024]
Abstract
Delayed graft function (DGF) after kidney transplantation heralds a worse prognosis. In patients with hyperoxaluria, the incidence of DGF is high. Oxalic acid is a waste product that accumulates when kidney function decreases. We hypothesize that residual diuresis and accumulated waste products influence the DGF incidence. Patients transplanted between 2018-2022 participated in the prospective cohort study. Pre-transplant concentrations of oxalic acid and its precursors were determined. Data on residual diuresis and other recipient, donor or transplant related variables were collected. 496 patients were included, 154 were not on dialysis. Oxalic acid, and glyoxylic acid, were above upper normal concentrations in 98.8%, and 100% of patients. Residual diuresis was ≤150 mL/min in 24% of patients. DGF occurred in 157 patients. Multivariable binary logistic regression analysis demonstrated a significant influence of dialysis type, recipient BMI, donor type, age, and serum creatinine on the DGF risk. Residual diuresis and glycolic acid concentration were inversely proportionally related to this risk, glyoxylic acid directly proportionally. Results in the dialysis population showed the same results, but glyoxylic acid lacked significance. In conclusion, low residual diuresis is associated with increased DGF incidence. Possibly accumulated waste products also play a role. Pre-emptive transplantation may decrease the incidence of DGF.
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Affiliation(s)
- Gideon Post Hospers
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, Netherlands
| | - Wesley J. Visser
- Department of Internal Medicine, Division of Dietetics, Erasmus MC, Rotterdam, Netherlands
| | - Jeroen G. H. P. Verhoeven
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, Netherlands
| | - Mirjam Laging
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, Netherlands
| | - Sara J. Baart
- Department of Epidemiology and Biostatistics, Erasmus MC, Rotterdam, Netherlands
| | | | - Dennis A. Hesselink
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, Netherlands
| | | | - Michiel G. H. Betjes
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, Netherlands
| | - Madelon van Agteren
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, Netherlands
| | - David Severs
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, Netherlands
| | - Jacqueline van de Wetering
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, Netherlands
| | - Robert Zietse
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, Netherlands
| | - Michel J. Vos
- Department of Clinical Chemistry Metabolic Diseases, University Medical Center, Groningen, Netherlands
| | - Ido P. Kema
- Department of Clinical Chemistry Metabolic Diseases, University Medical Center, Groningen, Netherlands
| | - Marcia M. L. Kho
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, Netherlands
| | - Marlies E. J. Reinders
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, Netherlands
| | - Joke I. Roodnat
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, Netherlands
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2
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Aziz F, Jorgenson M, Garg N. Secondary oxalate nephropathy and kidney transplantation. Curr Opin Organ Transplant 2023; 28:15-21. [PMID: 36342385 DOI: 10.1097/mot.0000000000001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE OF REVIEW Secondary hyperoxaluria is associated with poor kidney allograft outcomes after the kidney transplant. Calcium oxalate (CaOx) deposition is common in early allograft biopsies leading to acute tubular necrosis and poor kidney allograft function. Though treatment options for secondary hyperoxaluria are limited, it is crucial to identify patients at increased risk of oxalate nephropathy after the transplant. RECENT FINDINGS Recent data suggest that significant changes in renal replacement therapies and dietary modifications in high-risk patients can prevent kidney allograft damage from the calcium oxalate deposition leading to improve allograft outcomes. SUMMARY The accurate and timely diagnosis of secondary oxalate nephropathy in kidney transplant recipients is paramount to preserving graft function in the long-term. This review will discuss the incidence, risk factors, prevention, and management of oxalate nephropathy in the kidney allograft.
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Affiliation(s)
- Fahad Aziz
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health
| | - Margaret Jorgenson
- Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA
| | - Neetika Garg
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health
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3
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Cornell LD, Amer H, Viehman JK, Mehta RA, Lieske JC, Lorenz EC, Heimbach JK, Stegall MD, Milliner DS. Posttransplant recurrence of calcium oxalate crystals in patients with primary hyperoxaluria: Incidence, risk factors, and effect on renal allograft function. Am J Transplant 2022; 22:85-95. [PMID: 34174139 PMCID: PMC8710184 DOI: 10.1111/ajt.16732] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/30/2021] [Accepted: 06/19/2021] [Indexed: 01/25/2023]
Abstract
Primary hyperoxaluria (PH) is a metabolic defect that results in oxalate overproduction by the liver and leads to kidney failure due to oxalate nephropathy. As oxalate tissue stores are mobilized after transplantation, the transplanted kidney is at risk of recurrent disease. We evaluated surveillance kidney transplant biopsies for recurrent calcium oxalate (CaOx) deposits in 37 kidney transplants (29 simultaneous kidney and liver [K/L] transplants and eight kidney alone [K]) in 36 PH patients and 62 comparison transplants. Median follow-up posttransplant was 9.2 years (IQR: [5.3, 15.1]). The recurrence of CaOx crystals in surveillance biopsies in PH at any time posttransplant was 46% overall (41% in K/L, 62% in K). Higher CaOx crystal index (which accounted for biopsy sample size) was associated with higher plasma and urine oxalate following transplant (p < .01 and p < .02, respectively). There was a trend toward higher graft failure among PH patients with CaOx crystals on surveillance biopsies compared with those without (HR 4.43 [0.88, 22.35], p = .07). CaOx crystal deposition is frequent in kidney transplants in PH patients. The avoidance of high plasma oxalate and reduction of CaOx crystallization may decrease the risk of recurrent oxalate nephropathy following kidney transplantation in patients with PH. This study was approved by the IRB at Mayo Clinic.
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Affiliation(s)
- Lynn D. Cornell
- Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905
| | - Hatem Amer
- Division of Nephrology, Department of Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - Jason K. Viehman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota 55905
| | - Ramila A. Mehta
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota 55905
| | - John C. Lieske
- Division of Nephrology, Department of Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - Elizabeth C. Lorenz
- Division of Nephrology, Department of Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - Julie K. Heimbach
- Division of Transplant Surgery, William J. von Liebig Transplant Center, Mayo Clinic, Rochester, Minnesota 55905
| | - Mark D. Stegall
- Division of Transplant Surgery, William J. von Liebig Transplant Center, Mayo Clinic, Rochester, Minnesota 55905
| | - Dawn S. Milliner
- Division of Nephrology, Department of Medicine, Mayo Clinic, Rochester, Minnesota 55905
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4
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Geraghty R, Wood K, Sayer JA. Calcium oxalate crystal deposition in the kidney: identification, causes and consequences. Urolithiasis 2020; 48:377-384. [PMID: 32719990 PMCID: PMC7496019 DOI: 10.1007/s00240-020-01202-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/17/2020] [Indexed: 02/06/2023]
Abstract
Calcium oxalate (CaOx) crystal deposition within the tubules is often a perplexing finding on renal biopsy of both native and transplanted kidneys. Understanding the underlying causes may help diagnosis and future management. The most frequent cause of CaOx crystal deposition within the kidney is hyperoxaluria. When this is seen in native kidney biopsy, primary hyperoxaluria must be considered and investigated further with biochemical and genetic tests. Secondary hyperoxaluria, for example due to enteric hyperoxaluria following bariatric surgery, ingested ethylene glycol or vitamin C overdose may also cause CaOx deposition in native kidneys. CaOx deposition is a frequent finding in renal transplant biopsy, often as a consequence of acute tubular necrosis and is associated with poorer long-term graft outcomes. CaOx crystal deposition in the renal transplant may also be secondary to any of the causes associated with this phenotype in the native kidney. The pathophysiology underlying CaOx deposition is complex but this histological phenotype may indicate serious underlying pathology and should always warrant further investigation.
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Affiliation(s)
- R Geraghty
- Renal Services, The Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - K Wood
- Histopathology Department, The Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK
| | - J A Sayer
- Renal Services, The Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK. .,Translational and Clinical Research Institute, Faculty of Medical Sciences, International Centre for Life, Newcastle University, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK. .,NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK.
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5
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Palsson R, Chandraker AK, Curhan GC, Rennke HG, McMahon GM, Waikar SS. The association of calcium oxalate deposition in kidney allografts with graft and patient survival. Nephrol Dial Transplant 2020; 35:888-894. [PMID: 30165691 PMCID: PMC7849934 DOI: 10.1093/ndt/gfy271] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 07/24/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Whether calcium oxalate (CaOx) deposition in kidney allografts following transplantation (Tx) adversely affects patient outcomes is uncertain, as are its associated risk factors. METHODS We performed a retrospective cohort study of patients who had kidney allograft biopsies performed within 3 months of Tx at Brigham and Women's Hospital and examined the association of CaOx deposition with the composite outcome of death or graft failure within 5 years. RESULTS Biopsies from 67 of 346 patients (19.4%) had CaOx deposition. In a multivariable logistic regression model, higher serum creatinine [odds ratio (OR) = 1.28 per mg/dL, 95% confidence interval (CI) 1.15-1.43], longer time on dialysis (OR = 1.11 per additional year, 95% CI 1.01-1.23) and diabetes (OR = 2.26, 95% CI 1.09-4.66) were found to be independently associated with CaOx deposition. CaOx deposition was strongly associated with delayed graft function (DGF; OR = 11.31, 95% CI 5.97-21.40), and with increased hazard of the composite outcome after adjusting for black recipient race, donor type, time on dialysis before Tx, diabetes and borderline or acute rejection (hazard ratio 1.90, 95% CI 1.13-3.20). CONCLUSIONS CaOx deposition is common in allografts with poor function and portends worse outcomes up to 5 years after Tx. The extent to which CaOx deposition may contribute to versus result from DGF, however, cannot be determined based on our retrospective and observational data. Future studies should examine whether reducing plasma and urine oxalate prevents CaOx deposition in the newly transplanted kidney and whether this has an effect on clinical outcomes.
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Affiliation(s)
- Ragnar Palsson
- Renal Division, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Gary C Curhan
- Renal Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Helmut G Rennke
- Renal Pathology Service, Brigham and Women's Hospital, Boston, MA, USA
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Cassol CA, Braga JR, Hartage R, Satoskar AA, Nadasdy T, Brodsky SV. Lost in Transportation: Calcium Oxalate Crystals in Kidney Biopsy Specimens Fixed in Michel Medium May Disappear. Arch Pathol Lab Med 2019; 144:485-489. [PMID: 31403332 DOI: 10.5858/arpa.2019-0088-oa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Calcium oxalate (CaOx) deposits in a kidney biopsy specimen can be seen in acute or chronic kidney injury and in oxalate nephropathy. Although no established cutoff criteria to diagnose oxalate nephropathy versus incidental CaOx deposition in the kidney exist, these conditions require different treatment. We noticed a significant decrease in the number of CaOx deposits in the kidney biopsy cores that were fixed in Michel transport medium (MTM) as compared to their counterparts fixed in formalin. OBJECTIVE.— To investigate the impact of different fixatives on the number of CaOx deposits in kidney biopsy specimens. DESIGN.— Retrospective search for kidney biopsies with diagnosis of CaOx deposition was performed in our Renal Pathology Database between January 1, 2015 and October 15, 2018. RESULTS.— Seventy-six biopsies with an increased number of CaOx deposits were identified. CaOx deposits were counted on slides from the frozen tissue (MTM fixed or fresh frozen) and from the formalin-fixed cores. The density of CaOx deposits was significantly higher in formalin-fixed cores (13.6 ± 10.0/cm) than in MTM-fixed cores (3.2 ± 5.1/cm; P < .001). CaOx density in the kidney biopsy specimens decreased progressively with increased fixation time in MTM. No significant differences in the CaOx density between formalin-fixed and fresh frozen tissue were observed. CONCLUSIONS.— Our data demonstrate that fixation in MTM may result in a significant reduction in the number of CaOx deposits in a kidney biopsy specimen. This may make the diagnosis difficult, especially in small biopsy specimens with limited tissue in the formalin-fixed paraffin block.
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Affiliation(s)
- Clarissa A Cassol
- From the Department of Pathology, The Ohio State University, Columbus (Drs Cassol, Hartage, Satoskar, Nadasdy, and Brodsky); and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada (Dr Braga)
| | - Juarez R Braga
- From the Department of Pathology, The Ohio State University, Columbus (Drs Cassol, Hartage, Satoskar, Nadasdy, and Brodsky); and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada (Dr Braga)
| | - Ramon Hartage
- From the Department of Pathology, The Ohio State University, Columbus (Drs Cassol, Hartage, Satoskar, Nadasdy, and Brodsky); and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada (Dr Braga)
| | - Anjali A Satoskar
- From the Department of Pathology, The Ohio State University, Columbus (Drs Cassol, Hartage, Satoskar, Nadasdy, and Brodsky); and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada (Dr Braga)
| | - Tibor Nadasdy
- From the Department of Pathology, The Ohio State University, Columbus (Drs Cassol, Hartage, Satoskar, Nadasdy, and Brodsky); and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada (Dr Braga)
| | - Sergey V Brodsky
- From the Department of Pathology, The Ohio State University, Columbus (Drs Cassol, Hartage, Satoskar, Nadasdy, and Brodsky); and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada (Dr Braga)
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7
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Snijders MLH, Hesselink DA, Clahsen-van Groningen MC, Roodnat JI. Oxalate deposition in renal allograft biopsies within 3 months after transplantation is associated with allograft dysfunction. PLoS One 2019; 14:e0214940. [PMID: 30990835 PMCID: PMC6467373 DOI: 10.1371/journal.pone.0214940] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/22/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Calcium oxalate (CaOx) deposition in the kidney may lead to loss of native renal function but little is known about the prevalence and role of CaOx deposition in transplanted kidneys. METHODS In patients transplanted in 2014 and 2015, all for-cause renal allograft biopsies obtained within 3 months post-transplantation were retrospectively investigated for CaOx deposition. Additionally, all preimplantation renal biopsies obtained in 2000 and 2001 were studied. RESULTS In 2014 and 2015, 388 patients were transplanted, of whom 149 had at least one for-cause renal biopsy. Twenty-six (17%) patients had CaOx deposition. In the population with CaOx deposition: Patients had significantly more often been treated with dialysis before transplantation (89 vs. 64%; p = 0.011); delayed graft function occurred more frequently (42 vs. 23%; p = 0.038); and the eGFR at the time of first biopsy was significantly worse (21 vs. 29 ml/min/1.73m2; p = 0.037). In a multivariate logistic regression analysis, eGFR at the time of first biopsy (OR 0.958, 95%-Cl: 0.924-0.993, p = 0.019), dialysis before transplantation (OR 4.868, 95%-Cl: 1.128-21.003, p = 0.034) and the time of first biopsy after transplantation (OR 1.037, 95%-Cl: 1.013-1.062, p = 0.002) were independently associated with CaOx deposition. Graft survival censored for death was significantly worse in patients with CaOx deposition (p = 0.018). In only 1 of 106 preimplantation biopsies CaOx deposition was found (0.94%). CONCLUSION CaOx deposition appears to be primarily recipient-derived and is frequently observed in for-cause renal allograft biopsies obtained within 3 months post-transplantation. It is associated with inferior renal function at the time of biopsy and worse graft survival.
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Affiliation(s)
- Malou L H Snijders
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dennis A Hesselink
- Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Internal Medicine, Division of Nephrology and Transplantation, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marian C Clahsen-van Groningen
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Joke I Roodnat
- Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Internal Medicine, Division of Nephrology and Transplantation, University Medical Center Rotterdam, Rotterdam, The Netherlands
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8
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Accelerated Oxalosis Contributing to Delayed Graft Function after Renal Transplantation. Case Rep Transplant 2019; 2019:8942062. [PMID: 31019830 PMCID: PMC6452533 DOI: 10.1155/2019/8942062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/28/2019] [Indexed: 12/23/2022] Open
Abstract
Hyperoxaluria is an important and underrecognized cause for allograft dysfunction and loss after transplantation. It is potentially treatable if recognized in a timely fashion. Research is ongoing to expand the array of therapeutic options available to treat this. We present a case of a 59-year-old gentleman who underwent deceased donor renal transplantation that was complicated by delayed graft function necessitating continuation of renal replacement therapy. His initial biopsy showed extensive acute tubular necrosis with associated peritubular capillaritis and interstitial nephritis and oxalate crystals in several tubules. Despite receiving methylprednisolone to treat moderate acute cellular rejection, he remained dialysis dependent with minimal urine output. An interval renal allograft biopsy revealed residual acute tubular necrosis with extensive oxalate crystals now visible in many tubules. His plasma oxalate level was concurrently elevated to 19.3 μmol/L (reference range ≤ 1.9 μmol/L). He commenced calcium citrate to manage his hyperoxaluria and ultimately became dialysis independent at 3 weeks after transplantation. This case provides an important example of accelerated oxalate nephropathy as an underappreciated contributor to delayed graft function after renal transplantation. Our accompanying discussion provides an update on current therapeutic measures for managing this challenging condition.
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Moyses-Neto M, Brito BRS, de Araújo Brito DJ, Barros NDC, Dantas M, Salgado-Filho N, Costa RS, Silva GEB. Vitamin C-induced oxalate nephropathy in a renal transplant patient related to excessive ingestion of cashew pseudofruit (Anacardium occidentale L.): a case report. BMC Nephrol 2018; 19:265. [PMID: 30314464 PMCID: PMC6186097 DOI: 10.1186/s12882-018-1060-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/27/2018] [Indexed: 12/27/2022] Open
Abstract
Background Ingestion of vitamin C is generally regarded as harmless. Oxalate nephropathy is an infrequent condition and is characterized by oxalate deposition in the renal tubules, in some cases resulting in acute kidney injury. It can be caused by overproduction of oxalate in genetic disorders and, more frequently, as a secondary phenomenon provoked by ingestion of oxalate or substances that can be transformed into oxalate in the patient. Case presentation We present a case of acute oxalate nephropathy in a 59-year-old black male with type 2 diabetes mellitus, who received a kidney transplant 11 years prior. He ingested a large amount of cashew pseudofruit (“cashew apple”) during 1 month and developed acute kidney injury. His previous blood creatinine was 2.0 mg/dL, which increased to 7.2 mg/d; he required hemodialysis. He was subsequently discharged without need for dialysis; 3 months later his blood creatinine stabilized at 3.6 mg/dL. Conclusions This pseudofruit is rich in ascorbic acid (vitamin C) and poor in oxalate. Urinary oxalate excretion begins to increase when amounts of ascorbic acid above bodily requirements are ingested, and may provoke acute oxalate nephropathy. The patient’s oxalate acute nephropathy, in this case, was attributed to excessive vitamin C ingestion from the cashew pseudofruit associated with decreased renal function.
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Affiliation(s)
- Miguel Moyses-Neto
- Nephrology Division, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900 - Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | - Bruno Rafael Santos Brito
- Kidney Disease Prevention Centre and University Hospital, Federal University of Maranhão, Barão de Itapary Street, 227, Centro, São Luís, MA, 65020-070, Brazil
| | - Dyego José de Araújo Brito
- Kidney Disease Prevention Centre and University Hospital, Federal University of Maranhão, Barão de Itapary Street, 227, Centro, São Luís, MA, 65020-070, Brazil
| | - Noelia Dias Carneiro Barros
- Kidney Disease Prevention Centre and University Hospital, Federal University of Maranhão, Barão de Itapary Street, 227, Centro, São Luís, MA, 65020-070, Brazil
| | - Márcio Dantas
- Nephrology Division, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900 - Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | - Natalino Salgado-Filho
- Kidney Disease Prevention Centre and University Hospital, Federal University of Maranhão, Barão de Itapary Street, 227, Centro, São Luís, MA, 65020-070, Brazil
| | - Roberto Silva Costa
- Department of Pathology, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900 - Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | - Gyl Eanes Barros Silva
- Kidney Disease Prevention Centre and University Hospital, Federal University of Maranhão, Barão de Itapary Street, 227, Centro, São Luís, MA, 65020-070, Brazil. .,Department of Pathology, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900 - Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil.
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10
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Özdemir BH, Ayva Ş, Özdemir G, Ok Atılgan A, Akçay E, Özdemir FN, Haberal M. Renal Allograft With Calcium Oxalate Deposition: Association with Urinary Tract Infection and Development of Interstitial Fibrosis. EXP CLIN TRANSPLANT 2018. [PMID: 29528009 DOI: 10.6002/ect.tond-tdtd2017.p26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The interaction between calcium oxalate deposition and urinary tract infection is not well established. We aimed to identify the association between these and to determine the role of calcium oxalate deposition on interstitial fibrosis development. MATERIALS AND METHODS Renal allograft biopsies of 967 patients were reviewed to identify those with calcium oxalate deposition in the renal allograft, with 27 (2.8%) identified. Follow-up biopsies were conducted to reevaluate for calcium oxalate presence and interstitial fibrosis development. At time of biopsy, presence of urinary tract infection and oxaluria was also examined from medical records. RESULTS Mean time for development of calcium oxalate deposition in renal allografts was 1.7 ± 0.4 and 32.7 ± 21.6 months in patients with primary and secondary oxalosis, respectively (P < .001). Of 27 patients with calcium oxalate deposition, 7 (25.9%) showed tubulointerstitial nephritis, with 2 also having urinary tract infection. Four patients (14.8%) had only urinary tract infection. Causes of tubulointerstitial nephritis were secondary to bacterial infection in 2 and secondary to viral infection in 5 patients (2 polyomaviruses, 2 cytomegaloviruses, 1 adenovirus). Time until development of interstitial fibrosis after calcium oxalate deposition was 3.5 ± 2.1 and 10.3 ± 4.1 months in patients with primary and secondary oxalosis, respectively (P = .01). Time until graft loss after calcium oxalate deposition was 9.3 ± 7.8 and 21.8 ± 12 months in those with primary and secondary oxalosis (P < .001), with 1-, 3-, and 5-year kidney graft survival of 43%, 28%, and 0% and 100%, 100%, and 67% in those with primary and secondary oxalosis, respectively. CONCLUSIONS Calcium oxalate deposits increased the risk of urinary tract infection and tubulointerstitial nephritis, with bacteria inducing increased presence of calcium oxalate deposition in a renal allograft. Calcium oxalate deposition had a significant influence on interstitial fibrosis development, therefore negatively affecting graft survival.
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Affiliation(s)
- B Handan Özdemir
- From the Department of Pathology, Başkent University Faculty of Medicine, Ankara, Turkey
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11
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Selistre LDS, Cochat P, Rech DL, Parant F, de Souza VC, Dubourg L. Association between glomerular filtration rate (measured by high-performance liquid chromatography with iohexol) and plasma oxalate. J Bras Nefrol 2018; 40:73-76. [PMID: 29738022 PMCID: PMC6533971 DOI: 10.1590/1678-4685-jbn-3743] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 08/31/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Secondary hyperoxalemia is a multifactorial disease that affects several organs and tissues in patients with native or transplanted kidneys. Plasma oxalate may increase during renal failure because it is cleared from the body by the kidneys. However, there is scarce evidence about the association between glomerular filtration rate and plasma oxalate, especially in the early stages of chronic kidney disease (CKD). METHODS A case series focuses on the description of variations in clinical presentation. A pilot study was conducted using a cross-sectional analysis with 72 subjects. The glomerular filtration rate (GFR) and plasma oxalate levels were measured for all patients. Results: Median (IQR) GFR was 70.50 [39.0; 91.0] mL/min/1.73 m2. Plasma oxalate was < 5.0 µmol/L in all patients with a GFR > 30 mL/min/1.73m2. Among the 14 patients with severe CKD (GFR < 30 mL/min/1.73 m2) only 4 patients showed a slightly increased plasma oxalate level (between 6 and 12 µmol/L). CONCLUSION In non-primary hyperoxaluria, plasma oxalate concentration increases when GFR < 30mL/min/1.73 m2 and, in our opinion, values greater than 5 µmol/L with a GFR > 30 mL/min/1.73 m2 are suggestive of primary hyperoxaluria. Further studies are necessary to confirm plasma oxalate increase in patients with low GFR levels (< 30mL/min/1.73 m2).
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Affiliation(s)
| | - Pierre Cochat
- Université Claude-Bernard Lyon, Centre de Référence des Maladies
Rénales Rares Nephrogones, Service de Néphrologie et Rhumatologie Pédiatriques,
Lyon, France
| | | | - François Parant
- Hospices Civils de Lyon, GHS - Centre de Biologie Sud, UM
Pharmacologie - Toxicologie, F-69495, Pierre Bénite, France
| | | | - Laurence Dubourg
- Université Claude-Bernard, Groupement Hospitalier Edouard Herriot,
Hospices Civils de Lyon, UMR 5305, Rhone-Alpes, Lyon, France
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12
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First investigation on microcrystalline pathologies of kidney allografts through cellular scale physicochemical techniques. CR CHIM 2016. [DOI: 10.1016/j.crci.2015.09.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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13
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Taheri D, Gheissari A, Shaabani P, Tabibian SR, Mortazavi M, Seirafian S, Merrikhi A, Fesharakizadeh M, Dolatkhah S. Acute oxalate nephropathy following kidney transplantation: Report of three cases. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2015; 20:818-23. [PMID: 26664431 PMCID: PMC4652317 DOI: 10.4103/1735-1995.168408] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Calcium oxalate (CaOx) crystal deposition is a common finding immediately after kidney transplantation. However, small depositions of CaOx could be benign while extensive depositions lead to poor graft outcome. Here we report three cases with end-stage renal disease (ESRD), bilateral nephrolithiasis, and unknown diagnosis of primary hyperoxaluria (PH) who underwent a renal transplant and experienced an early-onset graft failure. Although an acute rejection was suspected, renal allograft biopsies and subsequent allograft nephrectomies showed extensive CaOx deposition, which raised a suspicion of PH. Even though increased urinary excretion of CaOx was found in all patients, this diagnosis could be confirmed with further tests including genetic study and metabolic assay. In conclusion, massive CaOx deposition in kidney allograft is an important cause of poor allograft survival and needs special management. Furthermore, our cases suggest patients with ESRD and a history of nephrolithiasis should be screened for elevated urinary oxalate excretion and rule out of PH.
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Affiliation(s)
- Diana Taheri
- Department of Pathology, Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran ; Department of Nephrology, Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alaleh Gheissari
- Department of Pediatric Nephrology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pooria Shaabani
- Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mojgan Mortazavi
- Department of Nephrology, Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shiva Seirafian
- Department of Nephrology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Merrikhi
- Department of Pediatric Nephrology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Fesharakizadeh
- Department of Surgery, School of Medicine, Islamic Azad University, Najaf Abad Branch, Isfahan, Iran
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14
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Oxalate nephropathy in systemic sclerosis: Case series and review of the literature. Semin Arthritis Rheum 2015; 45:315-20. [PMID: 26239907 DOI: 10.1016/j.semarthrit.2015.06.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 06/08/2015] [Accepted: 06/30/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To increase awareness of oxalate nephropathy as a cause of acute kidney injury (AKI) among systemic sclerosis patients with small intestinal dysmotility and malabsorption, and to prompt consideration of dietary modification and early treatment of predisposing causes of oxalate nephropathy in this population. METHODS Two cases of biopsy-proven oxalate nephropathy were identified among systemic sclerosis patients in the course of direct clinical care. Subsequently, a retrospective search of the Johns Hopkins Pathology databases identified a third patient with systemic sclerosis who developed oxalate nephropathy. RESULTS Among the three patients with qualifying biopsies, all three had systemic sclerosis with lower gastrointestinal involvement. All three presented with diarrhea, malabsorption, and AKI. In two of the three patients, diarrhea was present for at least 2 years before the development of AKI; in the third, incidental oxalate nephropathy was noted 3 years before she developed AKI and extensive oxalate nephropathy in the setting of a prolonged mycobacterium avium-intracellulare enteritis. In the first case, oxalate crystals were present by urinalysis months before diagnosis by biopsy; in the second, hyperoxaluria was diagnosed by urine collection immediately after; and in the third, oxalate crystals had been noted incidentally on post-transplant renal biopsy 3 years before the development of fulminant oxalate nephropathy. All three patients died within a year after diagnosis. CONCLUSIONS Patients with systemic sclerosis and bowel dysmotility associated with chronic diarrhea and malabsorption may be at risk for an associated oxalate nephropathy. Regular screening of systemic sclerosis patients with small bowel malabsorption syndromes through routine urinalysis or 24-h urine oxalate collection, should be considered. Further studies defining the prevalence of this complication in systemic sclerosis, the benefit of dietary modification on hyperoxaluria, the effect of treating small intestinal bowel overgrowth with antibiotics, and the effectiveness of probiotics, calcium supplements, or magnesium supplements to prevent hyperoxaluria-associated renal disease in these patients, are warranted.
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15
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Troxell ML, Houghton DC. The Basics of Renal Allograft Pathology. Surg Pathol Clin 2014; 7:367-87. [PMID: 26837445 DOI: 10.1016/j.path.2014.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Renal allograft biopsy provides critical information in the management of renal transplant patients, and must be analyzed in close collaboration with the clinical team. The histologic correlates of acute T-cell mediated rejection are interstitial inflammation, tubulitis, and endothelialitis; polyomavirus nephropathy is a potential mimic. Evidence of antibody-mediated rejection includes C4d deposition; morphologic acute tissue injury; and donor specific antibodies. Acute tubular injury/necrosis is a reversible cause of impaired graft function, especially in the immediate post-transplant period. Drug toxicity, recurrent disease, chronic injury, and other entities affecting both native and transplant kidneys must also be evaluated.
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Affiliation(s)
- Megan L Troxell
- Department of Pathology, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA.
| | - Donald C Houghton
- Department of Pathology, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA
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16
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Getting JE, Gregoire JR, Phul A, Kasten MJ. Oxalate nephropathy due to 'juicing': case report and review. Am J Med 2013; 126:768-72. [PMID: 23830537 DOI: 10.1016/j.amjmed.2013.03.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 03/11/2013] [Accepted: 03/11/2013] [Indexed: 02/08/2023]
Abstract
A patient presented with oxalate-induced acute renal failure that was attributable to consumption of oxalate-rich fruit and vegetable juices obtained from juicing. We describe the case and also review the clinical presentation of 65 patients seen at Mayo Clinic (Rochester, MN) from 1985 through 2010 with renal failure and biopsy-proven renal calcium oxalate crystals. The cause of renal oxalosis was identified for all patients: a single cause for 36 patients and at least 2 causes for 29 patients. Three patients, including our index patient, had presumed diet-induced oxalate nephropathy in the context of chronic kidney disease. Identification of calcium oxalate crystals in a kidney biopsy should prompt an evaluation for causes of renal oxalosis, including a detailed dietary history. Clinicians should be aware that an oxalate-rich diet may potentially precipitate acute renal failure in patients with chronic kidney disease. Juicing followed by heavy consumption of oxalate-rich juices appears to be a potential cause of oxalate nephropathy and acute renal failure.
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Affiliation(s)
- Jane E Getting
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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17
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Troxell ML, Houghton DC, Hawkey M, Batiuk TD, Bennett WM. Enteric oxalate nephropathy in the renal allograft: an underrecognized complication of bariatric surgery. Am J Transplant 2013; 13:501-9. [PMID: 23311979 DOI: 10.1111/ajt.12029] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 10/18/2012] [Accepted: 10/31/2012] [Indexed: 02/06/2023]
Abstract
Enteric hyperoxalosis is a recognized complication of bariatric surgery, with consequent oxalate nephropathy leading to chronic kidney disease and occasionally end-stage renal failure. In patients with prior gastrointestinal bypass surgery, renal allografts are also at risk of oxalate nephropathy. Further, transplant recipients may be exposed to additional causes of hyperoxalosis. We report two cases of renal allograft oxalate nephropathy in patients with remote histories of bariatric surgery. Conservative management led to improvement of graft function in one patient, while the other patient returned to dialysis. Interpretation of serologic, urine and biopsy studies is complicated by oxalate accumulation in chronic renal failure, and heightened excretion in the early posttransplant period. A high index of suspicion and careful clinicopathologic correlation on the part of transplant nephrologists and renal pathologists are required to recognize and treat allograft oxalate nephropathy. As the incidence of obesity and pretransplant bariatric surgery increases in the transplant population, allograft oxalate nephropathy is likely to be an increasing cause of allograft dysfunction.
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Affiliation(s)
- M L Troxell
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA.
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18
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Capolongo G, Abul-Ezz S, Moe OW, Sakhaee K. Subclinical celiac disease and crystal-induced kidney disease following kidney transplant. Am J Kidney Dis 2012; 60:662-7. [PMID: 22739230 DOI: 10.1053/j.ajkd.2012.02.342] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 02/29/2012] [Indexed: 11/11/2022]
Abstract
Decreased kidney function from kidney deposition of calcium oxalate has been described previously in inflammatory bowel disease and after jejuno-ileal and Roux-en-Y gastric bypass surgeries. Although celiac disease is the most prevalent bowel abnormality associated with intestinal malabsorption, its relationship to high kidney oxalate burden and decreased kidney function has not been established. We report a case of subclinical celiac disease and hyperoxaluria that presented with loss of kidney function as a result of high oxalate load in the absence of overt diarrhea, documented intestinal fat malabsorption, and nephrolithiasis. Subclinical celiac disease is commonly overlooked and hyperoxaluria is not usually investigated in kidney patients. We propose that this entity should be suspected in patients with chronic kidney disease in which the cause of kidney damage has not been clearly established.
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Affiliation(s)
- Giovanna Capolongo
- Charles & Jane Pak Center for Mineral Metabolism & Clinical Research, University of Texas Southwestern Medical Center, Dallas, USA
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19
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Primary nonfunction of renal allograft secondary to acute oxalate nephropathy. Case Rep Transplant 2011; 2011:876906. [PMID: 23213607 PMCID: PMC3504227 DOI: 10.1155/2011/876906] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 07/26/2011] [Indexed: 11/17/2022] Open
Abstract
Primary nonfunction (PNF) accounts for 0.6 to 8% of renal allograft failure, and the focus on causes of PNF has changed from rejection to other causes. Calcium oxalate (CaOx) deposition is common in early allograft biopsies, and it contributes in moderate intensity to higher incidence of acute tubular necrosis and poor graft survival. A-49-year old male with ESRD secondary to polycystic kidney disease underwent extended criteria donor kidney transplantation. Posttransplant, patient developed delayed graft function (DGF), and the biopsy showed moderately intense CaOx deposition that persisted on subsequent biopsies for 16 weeks, eventually resulting in PNF. The serum oxalate level was 3 times more than normal at 85 μmol/L (normal <27 μmol/L). Allograft nephrectomy showed massive aggregates of CaOx crystal deposition in renal collecting system. In conclusion, acute oxalate nephropathy should be considered in the differential diagnosis of DGF since optimal management could change the outcome of the allograft.
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20
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Elgstoen KBP, Johnsen LF, Woldseth B, Morkrid L, Hartmann A. Plasma oxalate following kidney transplantation in patients without primary hyperoxaluria. Nephrol Dial Transplant 2010; 25:2341-5. [DOI: 10.1093/ndt/gfq065] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Evenepoel P, Lerut E, Naesens M, Bammens B, Claes K, Kuypers D, Vermeersch P, Meijers B, Van Damme B, Vanrenterghem Y. Localization, etiology and impact of calcium phosphate deposits in renal allografts. Am J Transplant 2009; 9:2470-8. [PMID: 19681815 DOI: 10.1111/j.1600-6143.2009.02792.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Hypercalcemia, hypophosphatemia and renal phosphate wasting are common after kidney transplantation. Animal data suggest that these alterations in mineral metabolism may contribute to calcium phosphate (CaPhos) deposition in the kidney and renal dysfunction. We tested the hypothesis that CaPhos deposition is highly prevalent in the early posttransplant period and is related to a disturbed mineral metabolism. For this purpose, biomarkers of mineral metabolism and renal calcium and phosphorus handling were prospectively assessed in 201 renal transplant recipients. CaPhos deposits were observed in 4.6, 30.4 and 24.7% of protocol biopsies obtained at the time of engraftment, and 3 and 12 months thereafter, respectively. In multivariate logistic regression analysis, high calcium and low serum phosphorus levels were independently associated with renal CaPhos deposition at month 3. The extent of CaPhos deposition correlated significantly with the severity of mineral metabolism disturbances. Renal function after a mean follow-up of 33 months was similar in patients with and without CaPhos deposition at month 3. In conclusion, our data demonstrate that CaPhos deposition is highly prevalent in the early posttransplant period and suggest that a disordered mineral metabolism is implicated in its pathogenesis. The clinical relevance of CaPhos deposition remains to be established.
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Affiliation(s)
- P Evenepoel
- Department of Medicine, Division of Nephrology, University Hospital Leuven, Leuven, Belgium.
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22
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Parasuraman R, Venkat KK. Crystal-induced kidney disease in 2 kidney transplant recipients. Am J Kidney Dis 2009; 55:192-7. [PMID: 19880229 DOI: 10.1053/j.ajkd.2009.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 08/14/2009] [Indexed: 12/14/2022]
Affiliation(s)
- Ravi Parasuraman
- Division of Nephrology and Transplantation, William Beaumont Hospital, Royal Oak, MI 48703, USA.
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23
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Bagnasco SM, Mohammed BS, Mani H, Gandolfo MT, Haas M, Racusen LC, Montgomery RA, Kraus E. Oxalate deposits in biopsies from native and transplanted kidneys, and impact on graft function. Nephrol Dial Transplant 2008; 24:1319-25. [DOI: 10.1093/ndt/gfn697] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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24
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Rifkin SI. Transplantation for renal failure secondary to enteric hyperoxaluria: a case report. J Med Case Rep 2007; 1:31. [PMID: 17592638 PMCID: PMC1914082 DOI: 10.1186/1752-1947-1-31] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Accepted: 06/25/2007] [Indexed: 12/30/2022] Open
Abstract
Enteric hyperoxaluria can lead to renal failure. There have only been a few reports of renal transplantation as treatment of endstage renal disease secondary to enteric hyperoxaluria and results have been mixed. This report describes a patient with Crohn's disease who developed chronic renal failure from enteric hyperoxaluria. He subsequently had a successful renal transplant without any post-operative oxalate related complications and has satisfactory renal function almost three years later. Aggressive pre-transplant hemodialysis was not done. The literature associated with renal transplantation for enteric hyperoxaluria is reviewed.
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Affiliation(s)
- Stephen I Rifkin
- Division of Nephrology, University of South Florida College of Medicine, 2403 W, Azeele St, Tampa, Florida, 33609, USA.
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