Oxalosis in Renal Transplants Following Methoxyflurane Anaesthesia

Abstract

Eight patients underwent allogeneic renal transplantation under methoxyflurane anaesthesia. All exhibited further impairment of renal function. Histological examination of the renal cortex of seven of these patients revealed precipitation of calcium oxalate crystals, these being the probable cause of the subsequent decrease in renal function. A transient polyuric phase was seen in one case in which autologous renal transplantation was carried out. When halothane, ether or cyclopropane was used for anaesthesia in renal transplantation, crystal formation was not seen. In ninety-four patients who underwent various types of general surgery no harmful renal effect which could be attributed to methoxyflurane was detected. Methoxyflurane is not a recommended anaesthetic agent for renal transplantation.

Early Presence of Calcium Oxalate Deposition in Kidney Graft Biopsies is Associated with Poor Long-Term Graft Survival

“…Transplant surgery was performed according to normal surgical and anaesthesic procedures. Methoxyflurane an anaesthesic that may cause intense Ox production, was avoided (15). All patients received a triple immunosuppression regimen with prednisone, azathioprine and cyclosporine A.…”

Calcium Oxalate in Sarcoid Granulomas: With Particular Reference to the Small Ovoid Body and a Note on the Finding of Dolomite

“…13,32 A primary anomaly of oxalate metabolism is suggested. Such disturbances include congenital hyperoxalosis 63 (related to glycolate and glyoxylate metabolism 23,47 ); oxalosis following increased intake or absorption of dietary oxalate or of oxalate precursors such as ethylene glycol, 17 methoxyflurane, 6 and xylitol; and that associated with pyridoxine deficiency. 63 None is obviously implicated in sarcoidosis.…”

Histopathological occurrence and characterisation of calcium oxalate: a review.

“…J. Chaplin cardium, thyroid, and retinal pigment epithelium. Bergstrand et al (1972) described an interesting series of cases of oxalate deposition in kidneys transplanted under MOF anaesthesia and suggested that ischaemia and tubular necrosis may particularly predispose to oxalosis after MOF anaesthesia. A recent isolated report has implicated halothane anaesthesia in a similar way (Cotton et al, 1976).…”

“…Calcium oxalate is generally extremely inert, but tissue changes are presumably due to its local dissociation and liberation of toxic oxalate ions ). It has indeed been shown that, despite the low solubility of calcium oxalate, oxalate deposition in tissues is not necessarily an irreversible process (Bergstrand et al, 1972).…”