Oxalosis with nephrocalcinosis

Singh, Dharmendra; Sagade, Sharad N; Kamat, Madhav; Rb, Deshpande; Shah, Bharat

doi:10.1093/ndt/15.1.124

Cited by 10 publications

(6 citation statements)

References 2 publications

(1 reference statement)

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“…There are several reports in the literature where PH1 was recognized only after kidney transplantation due to early graft dysfunction [7][8][9][10][11][12][13][14]. In a few cases, there was a clinical suspicion of acute rejection, but allograft biopsy could only demonstrate deposits of birefringent calcium oxalate crystals [9,10,12].…”

Section: Discussionmentioning

confidence: 99%

Late diagnosis of primary hyperoxaluria after failed kidney transplantation

et al. 2009

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Primary hyperoxaluria type 1 (PH1) is a rare autosomal recessive inborn error of the glyoxylate metabolism that is based on absence, deficiency or mislocalization of the liver-specific peroxisomal enzyme alanine:glyoxylate aminotransferase. Hyperoxaluria leads to recurrent formation of calculi and/or nephrocalcinosis and often early end-stage renal disease (ESRD) accompanied by systemic calcium oxalate crystal deposition. In this report, we describe an adult female patient with only one stone passage before development of ESRD. With unknown diagnosis of PH, the patient received an isolated kidney graft and developed an early onset of graft failure. Although initially presumed as an acute rejection, the biopsy revealed calcium oxalate crystals, which then raised a suspicion of primary hyperoxaluria. The diagnosis was later confirmed by hyperoxaluria, elevated plasma oxalate levels and mutation of the AGXT gene, showing the patient to be compound heterozygous for the c.33_34InsC and c.508G > A mutations. Plasma oxalate levels did not decrease after high-dose pyridoxine treatment. Based on this case report, we would recommend in all patients even with a minor history of nephrolithiasis but progression to chronic renal failure to exclude primary hyperoxaluria before isolated kidney transplantation is considered.

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Section: Discussionmentioning

confidence: 99%

Late diagnosis of primary hyperoxaluria after failed kidney transplantation

et al. 2009

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“…Larger crystals obviously have the potential to cause luminal obstruction and severe tubular damage, resulting in both nephrocalcinosis and nephrolithiasis. Histological sections of a live related donor kidney transplant in a patient with (undiagnosed) primary hyperoxaluria type 1 reveal luminal calcium oxalate crystals, as well as interstitial calcification in the failing graft [125]. In a further case, an acutely failing cadaveric renal transplant, secondary to systemic oxalosis, revealed luminal calcium oxalate crystals, together with calcification of the tubular epithelium and blood vessels [126].…”

Section: Oxaluriasmentioning

confidence: 99%

Nephrocalcinosis: molecular insights into calcium precipitation within the kidney

2004

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Nephrocalcinosis may be defined as a generalized increase in the calcium content of the kidneys. This renal calcification may occur at a molecular, microscopic or macroscopic level leading to progressive amounts of renal damage. The major causes include those associated with an increase in urinary levels of calcium, oxalate and phosphate. Under these conditions, urine concentration and supersaturation leads to calcium crystal precipitation, which may be an intratubular event or initiate within the renal interstitium. The focus of discussion concerning renal calcification is often limited to factors that lead to renal stones (calculi and nephrolithiasis); however, nephrocalcinosis is a more sinister event, and often implies a serious metabolic defect. This review will discuss the hypotheses concerning initiating lesions of nephrocalcinosis using available laboratory and clinical studies and will examine whether new understanding of the molecular basis of tubulopathies, that lead to nephrocalcinosis, has given further insights.

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“…In patients with PH receiving a living related donor kidney without liver transplant, early renal allograft failure has been reported previously. 10 In that case, the body load of oxalosis that is sequestered in tissues and an abnormal liver remain problems. Thus, isolated kidney transplantation is not recommended for PH.…”

Section: Discussionmentioning

confidence: 99%