Abstract: TH-PO076
Oxalate Nephropathy in a Diabetic with Intentional Weight Loss
Session Information
- AKI: Liver Disease, Nephrotoxicity, Novel Therapeutics
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Srivastava, Kartikeya, Srivastava Fracture & Orthopaedic Care Centre, Agra, UP, India
- Russell, Charles, Tampa General Hospital, Tampa, Florida, United States
- Punchayil Narayanankutty, Naveen, Tampa General Hospital, Tampa, Florida, United States
Introduction
Oxalate induced nephropathy is a rare cause of acute kidney injury and has the potential to progress to end stage kidney disease.
Case Description
We saw a 60 years old diabetic female with an acute increase in serum creatinine and was admitted for acute renal failure, unspecified renal failure type. She has a history of hypertension, CKD 3b, reported retinopathy and a 50lbs intentional weight loss during the summer. She particularly resorted to foods like nuts and spinach with the avoidance of dairy. Routine evaluation revealed mild hyponatremia (which was attributed to the use of HCTZ). There was also microscopic hematuria. FeNa was 53% which was consistent with intrinsic renal pathology and Renal USG was ordered which revealed a slightly elevated bladder with non- obstructive nephrolithiasis.Testing for antibodies revealed negative ANCA, Anti GBM and ANA.
HCTZ and metformin were held as part of initial management with regular monitoriing. Her clinical presentation pointed towards a list of suspected differentials like Acute tubular necrosis secondary to hypotension, RPGN or a possible CKD secondary to T2DM. A lack of improvement in the creatinine levels despite the initial management prompted towards the need of a kidney biopsy. The biopsy revealed mild to moderate tubular injury with frequent oxalate crystals along-with features suggestive of diabetic nephropathy ( renal pathology class 2b)
Her acute rise in creatinine was attributed to the oxalate deposition (and not diabetes) and she was advised to avoid vitamin C and oxalate containing foods. A regular out patient follow-up had been scheduled and a discussion regarding genetic predisposition to oxalate deposition was initiated.
Discussion
There were a few challenges to the diagnosis. Retinopathy is a predictor of nephropathy in diabetic patients which posed the first obstacle towards diagnosis. The absence of proteinuria is another interesting finding, although it is now commonly accepted that a proportion of patients either with type 1 diabetes or type 2 diabetes have renal function loss without proteinuria, referred to as nonproteinuric diabetic kidney disease. The biopsy finding of oxalate crystals was in line with her history of rapid intentional weight loss where she resorted to foods like nuts and green leafy vegetables.