Oxalate Nephropathy Caused by Excessive Vitamin C Administration in 2 Patients With COVID-19

Fontana, Francesco; Cazzato, Silvia; Giovanella, Silvia; Ballestri, Marco; Leonelli, Marco; Mori, Giacomo; Alfano, Gaetano; Ligabue, Giulia; Magistroni, Riccardo; Cenacchi, G.; Antoniotti, Riccardo; Bonucchi, Decenzio; Cappelli, Gianni

doi:10.1016/j.ekir.2020.07.008

Cited by 51 publications

(55 citation statements)

References 9 publications

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“…An adverse effect associated with high-dose intravenous vitamin C administration (dose: 200 mg/kg/day, for 96 h) was reported in an Italian study on two patients with COVID-19-related sepsis [ 29 ]. The patients developed an acute tubular injury (ATI) and oxalate nephropathy after 2 and 8 days of treatment.…”

Section: Resultsmentioning

confidence: 99%

Vitamin C in the Treatment of COVID-19

2021

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Vitamin C is an essential nutrient that serves as antioxidant and plays a major role as co-factor and modulator of various pathways of the immune system. Its therapeutic effect during infections has been a matter of debate, with conflicting results in studies of respiratory infections and in critically ill patients. This comprehensive review aimed to summarize the current evidence regarding the use of vitamin C in the prevention or treatment of patients with SARS-CoV2 infection, based on available publications between January 2020 and February 2021. Overall, 21 publications were included in this review, consisting of case-reports and case-series, observational studies, and some clinical trials. In many of the publications, data were incomplete, and in most clinical trials the results are still pending. No studies regarding prevention of COVID-19 with vitamin C supplementation were found. Although some clinical observations reported improved medical condition of patients with COVID-19 treated with vitamin C, available data from controlled studies are scarce and inconclusive. Based on the theoretical background presented in this article, and some preliminary encouraging studies, the role of vitamin C in the treatment of patients with SARS-CoV-2 infection should be further investigated.

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Section: Resultsmentioning

confidence: 99%

Vitamin C in the Treatment of COVID-19

2021

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“…Oxalic acid binds minerals, and it has been linked to kidney stones and other health problems [ 36 ]. Some cases of oxalate nephropathy in COVID-19 patients were reported [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

The serum metabolome of COVID-19 patients is distinctive and predictive

Shi

Ren

et al. 2021

Metabolism

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Background Metabolism is critical for sustaining life, immunity and infection, but its role in COVID-19 is not fully understood. Methods Seventy-nine COVID-19 patients, 78 healthy controls (HCs) and 30 COVID-19-like patients were recruited in a prospective cohort study. Samples were collected from COVID-19 patients with mild or severe symptoms on admission, patients who progressed from mild to severe symptoms, and patients who were followed from hospital admission to discharge. The metabolome was assayed using gas chromatography–mass spectrometry. Results Serum butyric acid, 2-hydroxybutyric acid, L-glutamic acid, L -phenylalanine, l -serine, L-lactic acid, and cholesterol were enriched in COVID-19 and COVID-19-like patients versus HCs. Notably, d -fructose and succinic acid were enriched, and citric acid and 2-palmitoyl-glycerol were depleted in COVID-19 patients compared to COVID-19-like patients and HCs, and these four metabolites were not differentially distributed in non-COVID-19 groups. COVID-19 patients had enriched 4-deoxythreonic acid and depleted 1,5-anhydroglucitol compared to HCs and enriched oxalic acid and depleted phosphoric acid compared to COVID-19-like patients. A combination of d -fructose, citric acid and 2-palmitoyl-glycerol distinguished COVID-19 patients from HCs and COVID-19-like patients, with an area under the curve (AUC) > 0.92 after validation. The combination of 2-hydroxy-3-methylbutyric acid, 3-hydroxybutyric acid, cholesterol, succinic acid, L-ornithine, oleic acid and palmitelaidic acid predicted patients who progressed from mild to severe COVID-19, with an AUC of 0.969. After discharge, nearly one-third of metabolites were recovered in COVID-19 patients. Conclusions The serum metabolome of COVID-19 patients is distinctive and has important value in investigating pathogenesis, determining a diagnosis, predicting severe cases, and improving treatment.

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“…High doses of vitamin C supplementation is commonly used in COVID- 19 infection in India to counter the potential cytokine storm. There have been three other recent reports of dialysis dependent acute kidney injury with oxalate nephropathy in patients with COVID-19; two due to excessive vitamin C intake, both recovering after more than 45 days of hospitalisation [ 8 ], and one in a patient with collapsing focal segmental glomerulosclerosis [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Kidney transplant dysfunction in a patient with COVID − 19 infection: role of concurrent Sars-Cov 2 nephropathy, chronic rejection and vitamin C-mediated hyperoxalosis: case report

Anandh

Gowrishankar

Sharma³

et al. 2021

BMC Nephrol

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Background COVID-19 infection in kidney transplant recipients often lead to allograft dysfunction. The allograft injury has various histopathological manifestations. Our case illustrates the unusual combination of allograft rejection, acute kidney injury secondary to oxalate nephropathy and SARS CoV-2 nephropathy as the cause of irreversible allograft failure. Case presentation A 56 year old renal allograft recipient presented with a history of fever and diarrhoea for the preceding 4 weeks, tested positive for Sars-CoV2 on nasal swab and was found to have severe allograft dysfunction, necessitating haemodialysis. He subsequently underwent an allograft biopsy, which demonstrated antibody mediated rejection along with the presence of extensive oxalate deposition in the tubules. Ultrastructural examination demonstrated spherical spiked particles in the glomerular capillary endothelium and the presence of tubulo-reticular inclusions suggestive of an active COVID-19 infection within the kidney. The intra-tubular oxalate deposition was considered to be the result of high dose, supplemental Vitamin C used as an immune booster in many patients with COVID − 19 infection in India. Conclusions This case highlights the complex pathology that may be seen in following COVID-19 disease and the need for kidney biopsies in these patients to better understand the aetiology of disease.

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Oxalate Nephropathy Caused by Excessive Vitamin C Administration in 2 Patients With COVID-19

Cited by 51 publications

References 9 publications

Vitamin C in the Treatment of COVID-19

Vitamin C in the Treatment of COVID-19

The serum metabolome of COVID-19 patients is distinctive and predictive

Kidney transplant dysfunction in a patient with COVID − 19 infection: role of concurrent Sars-Cov 2 nephropathy, chronic rejection and vitamin C-mediated hyperoxalosis: case report

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