Abstract: FR-PO629
Oxalate Nephropathy in Patient with Diabetic Kidney Disease
Session Information
- Trainee Case Reports - IV
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 602 Diabetic Kidney Disease: Clinical
Authors
- Shivarov, Hristo, Lenox Hill Hospital - Northwell Health System, New York, New York, United States
- DeVita, Maria V., Lenox Hill Hospital- Northwell Health System, New York, New York, United States
Introduction
Secondary oxalate nephropathy is an uncommon condition that causes acute kidney injury with the potential for progression to end-stage renal disease. The diagnosis is based on high clinical suspicion and the findings from kidney biopsy.
Case Description
54 year old female with significant past medical history for Diabetes mellitus type I since age of 10, proliferative diabetic retinopathy, diabetic kidney disease, CKD stage 3b, HTN. She presented into the ED with abdominal pain, nausea and vomiting for less than 1 week. Laboratory work showed severe deterioration of her kidney function BUN 129 mg/dl and serum creatinine of 10.4 mg/dl and severe anemia – hemoglobin 6.6 g/dl. Baseline creatinine of 1.82 mg/dl, eGFR 31 ml/min one month prior. Furosemide and Enalapril were discontinued, rehydration therapy was initiated in the next two days without significant improvement in renal function, The evaluation for secondary causes for worsening of the renal function were negative: C3 and C4, hepatitis status, free light chains, UA – bland sediment <5 RBC, 5-10 WBC, no casts, proteinuria +, 34 mg/24 h. The patient was started on hemodialysis. Because of relatively fast progression of the renal failure inconsistent with diabetic nephropathy a renal biopsy was performed. The histological findings were consistent with widespread tubular oxalate crystal deposition, diffuse and nodular diabetes glomerulosclerosis and severe arterial sclerosis. After that a detailed history of her dietary habits was taken. The patient acknowledge for recent change in her diet habits including increased intake of green leafy vegetables, copious amount of green tea and almonds.
Discussion
A diet rich of oxalate can cause irreversible acute oxalate nephropathy, which can lead to ESRD in a patient with impaired renal function. Patients with predisposing conditions such as CKD and diabetic kidney disease are particularly at risk. Heightened awareness of the potential for acute oxalate nephropathy following a high green diet in susceptible individuals is needed to reduce the incidence of this preventable condition