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Stone HK, VandenHeuvel K, Bondoc A, Flores FX, Hooper DK, Varnell CD. Primary hyperoxaluria diagnosed after kidney transplant: A review of the literature and case report of aggressive renal replacement therapy and lumasiran to prevent allograft loss. Am J Transplant 2021; 21:4061-4067. [PMID: 34254430 PMCID: PMC8639665 DOI: 10.1111/ajt.16762] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/01/2021] [Accepted: 07/03/2021] [Indexed: 01/25/2023]
Abstract
Primary hyperoxaluria type 1 is a rare inherited disorder caused by abnormal liver glyoxalate metabolism leading to overproduction of oxalate, progressive kidney disease, and systemic oxalosis. While the disorder typically presents with nephrocalcinosis, recurrent nephrolithiasis, and/or early chronic kidney disease, the diagnosis is occasionally missed until it recurs after kidney transplant. Allograft outcomes in these cases are typically very poor, often with early graft loss. Here we present the case of a child diagnosed with primary hyperoxaluria type 1 after kidney transplant who was able to maintain kidney function, thanks to aggressive renal replacement therapy as well as initiation of a new targeted therapy for this disease. This case highlights the importance of having a high index of suspicion for primary hyperoxaluria in patients with chronic kidney disease and nephrocalcinosis/nephrolithiasis or with end stage kidney disease of uncertain etiology, as initiating therapies early on may prevent poor outcomes.
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Affiliation(s)
- Hillarey K. Stone
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Katherine VandenHeuvel
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH,Division of Pathology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Alexander Bondoc
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Francisco X. Flores
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - David K. Hooper
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH,James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Charles D. Varnell
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH,James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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2
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Cai Z, Ding M, Chen R, Zhu J, Li L, Wu X. Primary hyperoxaluria diagnosed after kidney transplantation: a case report and literature review. BMC Nephrol 2021; 22:393. [PMID: 34837989 PMCID: PMC8626922 DOI: 10.1186/s12882-021-02546-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 09/29/2021] [Indexed: 12/02/2022] Open
Abstract
Background Primary hyperoxaluria (PH) is a rare inherited autosomal recessive disease caused by disturbed glyoxylate metabolism. The disease is characterized by calcium oxalate crystal deposition in various organs, especially in the kidney. Due to the lack of current understanding of PH, nearly all patients are only initially diagnosed with PH when recurrent lithiasis and progressive end-stage renal disease occur. Many cases are not diagnosed in patients until renal allograft insufficiency occurs after renal transplantation. This case report and literature review aim to emphasize the need for careful pre-transplant PH screening of patients with bilateral nephrocalcinosis or nephrolithiasis. Case presentation Renal allograft insufficiency was diagnosed as PH after kidney transplantation. Here, we detail the complete clinical course, including computed tomography images of the original kidney and renal graft, histopathological images of a biopsy of the transplanted kidney, the results of laboratory and molecular genetic tests, and the treatment. In addition, we reviewed the literature from 2000 to 2021 and analyzed 19 reported cases of PH diagnosed after kidney transplantation, and provide a summary of the characteristics, complications, treatment, and prognosis of these cases. Conclusions By reviewing and analyzing these cases, we concluded that patients with a history of nephrocalcinosis or nephrolithiasis in both kidneys need preoperative screening for PH and appropriate treatment before kidney transplantation. Delayed graft function caused by PH is easily misdiagnosed as acute rejection, and needle biopsy should be performed at an early stage. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02546-0.
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Affiliation(s)
- Zhitao Cai
- Center of Nephrology, Dialysis and Transplantation, Renmin Hospital of Wuhan University, No.238 Jiefang Road, Wuchang District, Wuhan, 430060, Hubei, China
| | - Mao Ding
- Center of Nephrology, Dialysis and Transplantation, Renmin Hospital of Wuhan University, No.238 Jiefang Road, Wuchang District, Wuhan, 430060, Hubei, China
| | - Rengui Chen
- Center of Nephrology, Dialysis and Transplantation, Renmin Hospital of Wuhan University, No.238 Jiefang Road, Wuchang District, Wuhan, 430060, Hubei, China
| | - Jiefu Zhu
- Center of Nephrology, Dialysis and Transplantation, Renmin Hospital of Wuhan University, No.238 Jiefang Road, Wuchang District, Wuhan, 430060, Hubei, China
| | - Lian Li
- Center of Nephrology, Dialysis and Transplantation, Renmin Hospital of Wuhan University, No.238 Jiefang Road, Wuchang District, Wuhan, 430060, Hubei, China
| | - Xiongfei Wu
- Center of Nephrology, Dialysis and Transplantation, Renmin Hospital of Wuhan University, No.238 Jiefang Road, Wuchang District, Wuhan, 430060, Hubei, China.
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3
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Birtel J, Charbel Issa P, Herrmann P, Hoppe B, Büscher AK. Examination of the eye and retinal alterations in primary hyperoxaluria type 1. Nephrol Dial Transplant 2020; 37:255-257. [DOI: 10.1093/ndt/gfaa101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Johannes Birtel
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- Center for Rare Diseases Bonn (ZSEB), University of Bonn, Bonn, Germany
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Peter Charbel Issa
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Philipp Herrmann
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- Center for Rare Diseases Bonn (ZSEB), University of Bonn, Bonn, Germany
| | - Bernd Hoppe
- Center for Rare Diseases Bonn (ZSEB), University of Bonn, Bonn, Germany
- OxalEurope, The European Hyperoxaluria Consortium, Cologne, Germany
- Department of Pediatrics, Division of Pediatric Nephrology, University of Bonn, Bonn, Germany
| | - Anja Katrin Büscher
- Department of Pediatric Nephrology, University Children's Hospital Essen, Essen, Germany
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Atiskova Y, Dulz S, Schmäschke K, Oh J, Grabhorn E, Kemper MJ, Brinkert F. Oxalate retinopathy is irreversible despite early combined liver-kidney transplantation in primary hyperoxaluria type 1. Am J Transplant 2019; 19:3328-3334. [PMID: 31152479 DOI: 10.1111/ajt.15484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 04/30/2019] [Accepted: 05/08/2019] [Indexed: 01/25/2023]
Abstract
In primary hyperoxaluria type 1 (PH1), systemic oxalate deposition (oxalosis) in end-stage renal disease (ESRD) is associated with high morbidity and mortality, particularly in children with infantile oxalosis (IO). Combined liver and kidney transplantation (CLKT) is the only curative treatment option in these patients. After CLKT, systemic oxalosis decreases continuously, although only insufficient data are available regarding oxalate retinopathy (ROx), leading to severe visual impairment. We analyzed long-term follow-up data of ROx in 13 patients undergoing CLKT for PH1 at our center between 1998 and 2018. Age at transplantation was 1.3-14.2 years, including nine patients with IO. We performed visual acuity testing, slit lamp investigation, funduscopy, fundus photography, and spectral-domain optical coherence tomography (SD-OCT) imaging. Severe (grade 2-4) ROx was present in all nine children with IO but not in the four patients developing ESRD in adolescence. A significant negative correlation was found between age at onset of ESRD and grade of ROx (r = -0.66; P < .001). Notably, follow-up assessment after CLKT demonstrated no regression of ROx after a median of 5.3 years (range 0.6-14). The data show that despite early CLKT in IO, ROx is irreversible and the concomitant visual deterioration occurs prior to transplantation.
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Affiliation(s)
- Yevgeniya Atiskova
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simon Dulz
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kaja Schmäschke
- University Children's Hospital, Pediatric Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jun Oh
- University Children's Hospital, Pediatric Nephrology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Enke Grabhorn
- University Children's Hospital, Pediatric Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus J Kemper
- University Children's Hospital, Pediatric Nephrology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Asklepios Klinik Nord-Heidberg, Hamburg, Germany
| | - Florian Brinkert
- University Children's Hospital, Pediatric Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Birtel J, Herrmann P, Garrelfs SF, Dulz S, Atiskova Y, Diederen RM, Gliem M, Brinkert F, Holz FG, Boon CJ, Hoppe B, Charbel Issa P. The Ocular Phenotype in Primary Hyperoxaluria Type 1. Am J Ophthalmol 2019; 206:184-191. [PMID: 31078535 DOI: 10.1016/j.ajo.2019.04.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/15/2019] [Accepted: 04/17/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate ophthalmic features in a large group of patients with primary hyperoxaluria type 1 (PH1) and to determine the relation between ocular involvement and systemic disease severity. DESIGN Retrospective, cross-sectional, multicenter study of the OxalEurope Registry Network. METHODS Sixty-eight patients with PH1 were included. Infantile PH1 was diagnosed in 12 patients, and non-infantile PH1 was diagnosed in 56 patients (17 with end-stage renal disease). Ophthalmic examination included best corrected visual acuity (BCVA) testing and multimodal retinal imaging, including fundus photography and optical coherence tomography (OCT). In selected cases, fundus autofluorescence imaging was performed. RESULTS All eyes (n = 24) of infantile PH1 patients revealed severe retinal alterations and oxalate deposits, including macular crystals and hyperpigmentations (n = 9, 38%), and subretinal fibrosis (n = 15, 63%) with (n = 7, 47%) or without (n = 8; 53%) associated chronic retinal edema. In 9 eyes (38%, all with subretinal fibrosis), BCVA was significantly reduced (<20/50 Snellen equivalent). In contrast, all eyes (n = 112) of patients with non-infantile PH1 had a BCVA in the normal range (median, 20/20). Only 6 patients with non-infantile disease (11%, all with end-stage renal disease) showed mild, likely PH1-related retinal features. These deposits appeared as focal hyperreflective subretinal lesions on OCT imaging and were hyperautofluorescent on autofluorescence images. CONCLUSIONS Severe ocular alterations occur in infantile cases, whereas mild or no ocular alterations are typical in non-infantile PH1 patients. The natural history of (sub)retinal oxalate deposits, the pathogenesis of subretinal fibrosis, and exact factors influencing the overall severity of ocular disease manifestation remain to be determined.
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Cai R, Lin M, Chen Z, Lai Y, Huang X, Zhao G, Guo X, Xiong Z, Chen J, Chen H, Jiang Q, Liu S, Yang Y, Liang W, Zou M, Liu T, Chen W, Liu H, Peng J. Primary hyperoxaluria diagnosed after kidney transplantation failure: lesson from 3 case reports and literature review. BMC Nephrol 2019; 20:224. [PMID: 31215412 PMCID: PMC6582561 DOI: 10.1186/s12882-019-1402-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 05/28/2019] [Indexed: 12/16/2022] Open
Abstract
Background Primary hyperoxaluria (PH) is a rare inborn disorder of the metabolism of glyoxylate, which causes the hallmark production oxalate and forms insoluble calcium oxalate crystals that accumulate in the kidney and other organs. Since the manifestation of PH varies from recurrent nephrolithiasis, nephrocalcinosis, and end-stage renal disease with age at onset of symptoms ranging from infancy to the sixth decade, the disease remains undiagnosed until after kidney transplantation in some cases. Case presentation Herein, we report 3 cases of PH diagnosed after kidney transplantation failure, providing the comprehensive clinical course, the ultrasonic image of renal graft and pathologic image of the biopsy, highlighting the relevance of biopsy findings and the results of molecular genetic testing. We also focus on the treatment and the unfavorable outcome of the patients. Meanwhile, we review the literature and show the additional 10 reported cases of PH diagnosed after kidney transplantation. Additionally, we discuss the progressive molecular understanding of the mechanisms involved in PH and molecular therapy. Conclusions Overall, the necessity of preoperative screening of PH in all patients even with a minor history of nephrolithiasis and the importance of proper treatment are the lessons we learn from the 3 cases, which prompt us to avoid tragedies. Electronic supplementary material The online version of this article (10.1186/s12882-019-1402-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ruiming Cai
- Department of Organ Transplantation, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
| | - Minzhuang Lin
- Department of Organ Transplantation, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
| | - Zhiyong Chen
- Department of Organ Transplantation, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
| | - Yongtong Lai
- Department of Organ Transplantation, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
| | - Xianen Huang
- Department of Organ Transplantation, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
| | - Guozhi Zhao
- Department of Organ Transplantation, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
| | - Xuekun Guo
- Department of Organ Transplantation, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
| | - Zhongtang Xiong
- Department of Pathology, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, 510150, People's Republic of China
| | - Juan Chen
- Department of Pathology, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, 510150, People's Republic of China
| | - Hui Chen
- Department of Pathology, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, 510150, People's Republic of China
| | - Qingping Jiang
- Department of Pathology, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, 510150, People's Republic of China
| | - Shaoyan Liu
- Department of Pathology, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, 510150, People's Republic of China
| | - Yuexin Yang
- Department of Pathology, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, 510150, People's Republic of China
| | - Weixiang Liang
- Department of Ultrasound, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
| | - Minhui Zou
- Department of Ultrasound, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
| | - Tao Liu
- Department of Ultrasound, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
| | - Wenfang Chen
- Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
| | - Hongzhou Liu
- Department of Clinical Laboratory, Guangzhou Kingmed Center for Clinical Laboratory Co., Ltd, Guangzhou, 510330, China
| | - Juan Peng
- Department of Pathology, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, 510150, People's Republic of China.
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DETAILED CLINICAL PHENOTYPING OF OXALATE MACULOPATHY IN PRIMARY HYPEROXALURIA TYPE 1 AND REVIEW OF THE LITERATURE. Retina 2017; 36:2227-2235. [PMID: 27135212 DOI: 10.1097/iae.0000000000001058] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the structural and functional characteristics of oxalate retinopathy. METHODS Five patients with molecularly confirmed primary hyperoxaluria (PH) Type 1 underwent multimodal retinal imaging (spectral-domain optical coherence tomography, white light, and HRA multispectral imaging) and functional testing, including color vision testing, Goldmann perimetry, and International Society for Clinical Electrophysiology of Vision standard electrophysiological testing. RESULTS Four distinct retinal phenotypes are presented. One patient with a c.[33dupC]; c.[731T>C] mutation showed bilateral perifoveal retinal pigment epithelium hyperplasia. The fundus in the four other patients, all of whom share an identical homozygous c.[33dupC] mutation, ranged from normal to bilateral widespread distribution of retinal crystals and confluent macular retinal pigment epithelium hyperplasia with subfoveal fibrosis. All patients who had developed end-stage renal disease showed some sign of retinopathy, more severe with earlier onset. CONCLUSION Retinopathy in PH Type 1 shows considerable interindividual variation. No correlation between genotype and retinal phenotype was detected. Oxalate crystals at the level of the retinal pigment epithelium seem to be irreversible. A proposed clinical grading system of oxalate maculopathy, based on a literature review, may provide clinicians with a tool to better predict visual function and prognosis.
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Turkoglu EB, Ilhan HD, Dikmen B, Bilgin AB, Apaydın KC. Crystalline retinopathy in a 5-year-old girl with primary hyperoxaluria. J Fr Ophtalmol 2015; 38:e201-2. [PMID: 26371984 DOI: 10.1016/j.jfo.2014.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/13/2014] [Accepted: 11/12/2014] [Indexed: 11/26/2022]
Affiliation(s)
- E B Turkoglu
- Akdeniz University, Department of Ophthalmology, Dumlupinar Blv, 07058 Antalya, Turkey.
| | - H D Ilhan
- Akdeniz University, Department of Ophthalmology, Dumlupinar Blv, 07058 Antalya, Turkey
| | - B Dikmen
- Akdeniz University, Department of Ophthalmology, Dumlupinar Blv, 07058 Antalya, Turkey
| | - A B Bilgin
- Akdeniz University, Department of Ophthalmology, Dumlupinar Blv, 07058 Antalya, Turkey
| | - K C Apaydın
- Akdeniz University, Department of Ophthalmology, Dumlupinar Blv, 07058 Antalya, Turkey
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Abstract
Inherited metabolic diseases that affect the liver are a frequent cause of liver failure in children, but other disorders more commonly cause liver failure in adulthood where they may present with chronic liver disease and, less frequently, with acute liver failure. The identification of the underlying genetic defect for many of these inherited disorders has improved our understanding of their pathophysiology and impacted on the indications for and timing of liver transplant, yielding better outcomes. Screening for disease and genetic counseling of family members may help prevent adverse outcomes in relatives of affected individuals. Timely liver transplantation offers correction of the inherited metabolic defect and restores liver function when medical therapy is not possible or when complications of liver disease arise. Some inherited metabolic diseases have their defect based in the liver and lead not to liver disease, but to other end organ damage. Earlier detection of these disorders may prevent pathological injury by treatment of the underlying disease or by pre-emptive liver transplant. In some instances where damage of other organs has already occurred, dual organ transplant with liver and another organ may be needed. Improvement in the technical aspects of performing liver transplantation and posttransplant care has led to better outcomes for those with inherited metabolic disorders of the liver.
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Affiliation(s)
- M L Schilsky
- Department of Medicine and Surgery, Division of Digestive Diseases, Section of Transplantation and Immunology, Yale University School of Medicine, New Haven, Connecticut, USA.
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Taşlı F, Özkök G, Ok ES, Soyer N, Mollamehmetoğlu H, Vardar E. Massive bone marrow involvement in an end stage renal failure case with erythropoietin-resistant anemia and primary hyperoxaluria. Ren Fail 2013; 35:1167-9. [PMID: 23879652 DOI: 10.3109/0886022x.2013.815564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Primary hyperoxaluria is a rare autosomal recessive disorder. Type 1 PH is the most common form and develops due to a defect in a liver specific enzyme the alanine aminotransferase enzyme. As a result of the enzyme deficiency, there is an overproduction of oxalate and excessive urinary excretion. Recurrent urolithiasis and nephrocalcinosis are the most important findings of the disorder and often at the beginning end-stage renal disease develops. This report presents a case backed up by literature of a patient with end stage renal failure and erythropoietin-resistant anaemia whose bone marrow biopsy showed crystal deposition which received delayed diagnosis of oxalosis.
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Affiliation(s)
- Funda Taşlı
- Department of Pathology, Bozyaka Training and Research Hospital, Izmir, Turkey.
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