A hidden cause of oxalate nephropathy: a case report

Abstract

Background Oxalate nephropathy is a rare disorder that can result in acute kidney injury (AKI) and progresses to end-stage kidney disease (ESKD). The causes can be either primary or secondary. Primary hyperoxaluria includes a group of hereditary disorders with enzymatic defects in the glyoxylate pathway, resulting in decreased oxalate metabolism. Secondary hyperoxaluria, often overlooked can result from increased intestinal absorption, nutritional deficiencies, decreased fluid intake, impaired excretion, and increased dietary consumption of oxalate. Case presentation We present a Caucasian case of acute oxalate induced nephropathy associated with consumption of large quantities of green vegetables in a patient with chronic kidney disease (CKD). Imaging study showed no evidence of kidney stone, but a kidney biopsy revealed acute tubular injury, tubular atrophy, interstitial fibrosis, and dense tubular deposition of calcium oxalate crystals. Upon further questioning the patient, we learned that in the months prior to presentation, he had very significantly increased his consumption of green vegetables. Because of no clinical improvement, the patient was initiated and maintained on hemodialysis. Conclusion This report illustrates a case of acute oxalate nephropathy in the setting of very high dietary consumption of oxalate-rich foods in a patient with advanced CKD. Special attention should be given to the secondary causes of hyperoxaluria in patients with predisposing conditions such as CKD.

Secondary oxalate nephropathy and kidney transplantation

“…Chronic kidney disease (CKD) is associated with increased serum oxalate concentrations. Higher oxalate concentrations lead to oxalate binding with calcium to form calcium oxalate crystals, which can result in oxalate nephropathy [15][16][17].…”

Design and Synthesis of New Pyrimidine-Quinolone Hybrids as Novel hLDHA Inhibitors

“…Recently, h LDHA has also been shown to be implicated in other diseases such as primary hyperoxaluria (PH), which converts glyoxylate into oxalate [ 10 , 11 ]. When oxalate is overproduced, calcium oxalate crystals appear in the kidney, leading to urolithiasis, nephroncalcinosis, renal failure [ 12 ], and, eventually, end-stage renal disease [ 13 , 14 , 15 ]. Consequently, the h LDHA enzyme is an ideal therapeutic target for cancer and PH treatment.…”

Influência da oxalúria na progressão da doença renal crônica

“…Todavia, devemos ter atenção neste sentido, pois a dieta plant-based tem se mostrado uma excelente alternativa dietética para os pacientes com doença renal crônica 91,92,93,94,95 , porém sabe-se que as principais fontes de oxalato são de origem vegetal, portanto, deve-se ter cuidado com o consumo exagerado e repetitivo de alimentos muito ricos em oxalato para evitar qualquer risco de prejuízo para os rins 96,97,98,99 .…”

“…Embora no exame de imagem não tenha sido revelado cálculo renal, na biópsia foi possível observar deposição extensa de cristais de oxalato de cálcio, responsáveis por causar edema e injúria tubular, inflamação e fibrose intersticial. Este paciente havia iniciado há três meses uma dieta rica em vegetais folhosos verdes, ricos em oxalato, e neste intervalo de tempo sua filtração glomerular basal passou de 34 ml/min/1.73 m 2 para 7 ml/min/1.73 m 2 , sendo necessário iniciar hemodiálise 52 .…”

“…Além disso, com o objetivo de minimizar possíveis lesões teciduais, inflamação, fibrose e evitar prejuízo renal, estudos também têm investigado estratégias para o controle da absorção e excreção de oxalato no organismo, como o seu controle de ingestão dietética, que tem se mostrado eficaz para diminuir a excreção desse componente em pacientes com nefropatias 52,53,54,55 . O uso de bactérias que possam metabolizar o oxalato no intestino, embora estudos recentes apresentem resultados controversos, é uma alternativa a ser investigada 56,57,58,59,60 .…”