Abstract: SA-PO0056
Hypocitraturia as a Rare Cause of Interstitial Nephritis
Session Information
- AKI: Novel Patient Populations and Case Reports
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Dhayalan, Dhayanithi, Adventist Health Central Valley Network, Hanford, California, United States
- Adapa, Sreedhar R., Adventist Health Central Valley Network, Hanford, California, United States
- Pausescu, Dragos G, Adventist Health Central Valley Network, Hanford, California, United States
- Rajendran, Abinaya, Pondicherry Institute of Medical Sciences, Puducherry, PY, India
Introduction
Hypocitraturia has a long and well-documented history of its inhibitory effect on calcium salt precipitation in the kidneys, resulting in calcium oxalate stone formation in kidneys. However, it can sometimes occur without overt nephrolithiasis or identifiable obstruction, presenting instead with AKI and interstitial nephritis (IN) on biopsy. This type of presentation remains an elusive diagnosis, as hypocitraturia lacks sufficient medical literature describing this unique manifestation.
Case Description
A 37-year-old woman with stage 2 chronic kidney disease due to type 2 diabetes mellitus and NSAID use presented with a striking increase in serum creatinine from her baseline of 0.8 mg/dL to 7.8 mg/dL. Despite limited improvement with hydration (S.Cr decreased to 4.0 mg/dL), a renal biopsy was performed, revealing acute interstitial nephritis. A trial of corticosteroids led to minimal improvement in kidney function. However, over time, her renal function continued to decline, eventually requiring hemodialysis. A second biopsy demonstrated active chronic tubulointerstitial nephritis and acute tubular necrosis (ATN). A workup for secondary causes of IN—including tests for scleroderma, SSA/SSB antibodies, dsDNA, and heavy metal exposure(lead, cadmium)—was negative and failed to identify an etiology. The diagnostic breakthrough came with the discovery of markedly low urinary citrate levels. Initiation of potassium citrate therapy resulted in significant and sustained improvement in renal function, ultimately allowing for the discontinuation of dialysis.
Discussion
While hypocitraturia is traditionally associated with nephrolithiasis/nephrocalicnosis, it may also present as interstitial nephritis in the absence of stone formation. Although such cases have not been previously reported, this case aims to raise awareness of this potential etiology and highlight the importance of considering hypocitraturia in similar clinical presentations. Further studies and additional case reports are needed to better characterize the relationship between hypocitraturia and interstitial nephritis, as this appears to be the first reported case of its kind.