What is oxalate nephropathy

In this case kidney biopsy is essential in making the correct diagnosis. Therefore, a high index of suspicion for this disorder should be maintained in the presence of unexplained metabolic acidosis, hyperosmolality, unexplained AKI, and neurologic dysfunction.

Save my name, email, and website in this browser for the next time I comment. Follow ASNKidney. Read Later Share. Leave a Reply Cancel reply. Facebook Twitter Instagram.

Thiamine and pyridoxine are essential cofactors in the glyoxylate pathway, and a deficiency results in increased oxalate formation [ 22 ]. The third mechanism occurs in the setting of significantly decreased fluid intake. Lower fluid intake leads to lower urine output, hence promoting the formation of oxalate stones through increased concentration of urine oxalate.

The fourth mechanism is decreased oxalate excretion. In chronic kidney disease, lower GFR is associated with elevated plasma oxalate levels [ 23 ].

The degree of kidney function impairment is often correlated with the serum oxalate concentration [ 24 ]. This is because oxalate is removed from the body almost entirely by glomerular filtration and by secretion at the level of the proximal tubule [ 25 , 26 , 27 , 28 , 29 , 30 ].

Finally, increased dietary oxalate may lead to secondary hyperoxaluria, particularly in patients with underlying CKD. Oxalate is present in a wide variety of leafy green vegetables and fruits. Table 3 includes a list of common foods high in oxalate. In addition, vitamin C and ethylene glycol are important sources of oxalate precursors.

Dietary oxalate is absorbed in the intestines by SLC26 family of transporters, via both paracellular and transcellular pathways [ 33 ]. The intestinal absorption of oxalate is affected by the bioavailability of the ingested oxalate [ 34 ]. The disease spectrum of hyperoxaluria ranges from nephrocalcinosis, nephrolithiasis to oxalate nephropathy.

Nephrocalcinosis and nephrolithiasis may remain asymptomatic, with slow CKD progression, often discovered incidentally on radiographic imaging. In such event, renal replacement therapy may be required and if concern for primary hyperoxaluria is present, combined liver and kidney transplantations may need to be considered [ 5 , 36 , 37 ].

In summary, our patient with underlying CKD stage G3B developed acute oxalate nephropathy leading to ESKD from secondary oxalosis due to excessive consumption of oxalate-rich foods and likely decreased fluid intake. Patients with predisposing conditions such as CKD have a higher risk of developing oxalate-induced nephropathy.

In addition, our case illustrates the importance of a kidney biopsy in determining the etiology of AKI when the etiology remains elusive. Therefore, in addition to the typical work-up, special attention should be warranted to the dietary habits of patients at high risk, such as those with underlying CKD. Williams HE. Oxalic acid and the hyperoxaluric syndromes.

Kidney Int. The significance of oxalate in renal failure. Am J Kidney Dis. Oxalate content of foods and its effect on humans. Asia Pac J Clin Nutr. Hatch M, Freel RW. Intestinal transport of an obdurate anion: oxalate. Urol Res. Secondary hyperoxaluria: a risk factor for kidney stone formation and renal failure in native kidneys and renal grafts. Transplant Rev Orlando. Article Google Scholar. Cochat P, Rumsby G. Primary hyperoxaluria. N Engl J Med.

Hoppe B. An update on primary hyperoxaluria. Nat Rev Nephrol. International registry for primary hyperoxaluria. Am J Nephrol. PubMed Article Google Scholar. Primary hyperoxaluria Type 1: indications for screening and guidance for diagnosis and treatment. Nephrol Dial Transplant.

Management of primary hyperoxaluria: efficacy of oral citrate administration. Pediatr Nephrol. Results of long-term treatment with orthophosphate and pyridoxine in patients with primary hyperoxaluria. The primary hyperoxalurias. Hyperoxaluria: a gut-kidney axis? Hyperoxaluria after modern bariatric surgery: case series and literature review. Int Urol Nephrol. Oxalate nephropathy associated with chronic pancreatitis.

Clin J Am Soc Nephrol. Determinants of urolithiasis in patients with intestinal fat malabsorption. The association of nephrolithiasis with cystic fibrosis. Enteric hyperoxaluria and renal failure associated with lymphangiectasia. Orlistat-induced oxalate nephropathy may be dose-independent and present as a late manifestation.

J La State Med Soc. PubMed Google Scholar. Oxalate nephropathy induced by octreotide treatment for acromegaly: a case report. J Med Case Rep. Acute oxalate nephropathy associated with Clostridium difficile colitis. Dietary risk factors for hyperoxaluria in calcium oxalate stone formers. Plasma level and renal clearance of oxalate in normal subjects and in patients with primary hyperoxaluria or chronic renal failure or both. Clin Sci Lond. Urinary excretion of oxalate in renal failure.

The biosynthesis and turnover of oxalate in normal and hyperoxaluric subjects. J Clin Invest. For commercial re-use, please contact journals. Issue Section:. Download all slides. Comments 0. Add comment Close comment form modal. I agree to the terms and conditions. You must accept the terms and conditions. Add comment Cancel. Submit a comment. Comment title. You have entered an invalid code. Submit Cancel. Thank you for submitting a comment on this article. Your comment will be reviewed and published at the journal's discretion.

Please check for further notifications by email. View Metrics. Email alerts Article activity alert. Advance article alerts. New issue alert.