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Kidney Week

Abstract: PO0037

Late Presentations of Secondary Oxalate Nephropathy

Session Information

Category: Trainee Case Report

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Hale, Muna, The University of Oklahoma - Tulsa, Tulsa, Oklahoma, United States
  • Kathuria, Pranay, The University of Oklahoma - Tulsa, Tulsa, Oklahoma, United States
Introduction

Secondary Oxalate nephropathy is an important differential diagnosis for acute kidney injury (AKI) in chronic malabsorptive disease. Mean presentation is typically within 1-2 years. The following three cases are example of late, abrupt presentations of secondary oxalate nephropathy.

Case Description

Our first case includes a 69-year-old female, with gastric bypass surgery 14 years prior, who presented to emergency room (ER) with AKI. Six months prior her creatinine (Cr) was 1.6 mg/dL, but abruptly increased to 5.99 mg/dL. Serologic work up was negative. Renal biopsy was obtained that revealed deposition of oxalate crystals within renal tubules (Figure 1). Our second case showed a 59-year-old male with history of recurrent pancreatitis due to bulimia that presented to the ER for nausea and vomiting. In the ER, patient had a serum Cr of 5.79 mg/dL. Two months prior, Cr was 1.1 mg/dL. Renal biopsy showed widespread oxalate crystals in the interstitium. The last case was a 48-year-old male with chronic pancreatitis who presented with AKI with suspect acute tubular necrosis. He had been diagnosed with chronic pancreatitis for at least 6 years with Cr 0.9 mg/dL. Patient’s Cr remained at 4.00 mg/dL one month later. Renal biopsy revealed interstitial fibrosis and calcium oxalate crystals.

Discussion

Secondary oxalate nephropathy is a side effect of malabsorptive gastrointestinal (GI) disorders. According to prior case series, the mean presentation of oxalate nephropathy is 1-2 years. These cases illustrate that secondary oxalate nephropathy can present at a later course with rapid onset. Patients also likely progress to ESRD after diagnosis. A systemic review of 108 cases, with 13 months follow up, showed 55% of patients required hemodialysis. Currently, there is no treatment and lifestyle changes include a low fat, oxalate diet. Secondary oxalate nephropathy should be considered in the differential of all patients with malabsorptive states presenting with AKI.

Figure 1