Abstract: PUB022
Eating Your Greens Is Not Always the Best in Oxalate Nephropathy
Session Information
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Thiruvarudsothy, Srikanth, Virtua Health Inc, Marlton, New Jersey, United States
- Srikanth, Theesitha, Brown University, Providence, Rhode Island, United States
Introduction
Oxalate nephropathy is a known enitity (ON) is defined by an acute or chronic decrease in kidney function associated with the deposition of calcium oxalate crystals, in kidney tubules. There is also typically acute tubular injury and an associated acute/chronic interstitial nephritis or fibrosis. It can be inherited or acquired. We are presenting case of OXalate nephropathy in a 62 YO woman with history of gastric bypass surgery, who ended up with ESRD requiring dialysis with diet change.
Case Description
This is a 62 year-old woman with h/o HTN for two years, Gastric bypass surgery (2005), was seen by nephrology for lower extremity edema as well as worsening renal failure. She was hospitalized for acute kidney injury and underwent extensive work-up which were mostly unremarkable. She underwent a renal biopsy on 6/9. Renal biopsy results showed diffuse global glomerulosclerosis (53%), acute tubular injury with increased oxalate crystals, severe interstitial fibrosis and severe arterial sclerosis. This was consistent with oxalate nephropathy. On questioning, it was found that about 8 months prior to the presentation, she started on a juicing diet which included seeds, spinach, kale etc. Due to the finding of active inflammation, we decided give her a trial of prednisone. Steroids were tapered off in the next four months. Unfortunately needed to start dialysis 2 months.
Discussion
Hyperoxaluria can be inherited disorders of glyoxylate metabolism leading to hepatic oxalate overproduction (primary hyperoxaluria), or increased intestinal oxalate absorption (secondary hyperoxaluria). In our case patient with the history of Gatric bypass who changed her diet to consuming vegetables especially leafy greens likely lead to the increased absorption of Oxalate.This lead to the irreversible kidney injury that was proven with renal biopsy, and eventually her needing dialysis. She is now s/p kidney transplant and doing well. Gastric bypass can be associated with variety of known nutritional abnormalities but also with underdiagnosed entities such as oxalate nephropathy due to increased absorption. Abrupt diet changes should be discussed with these patients in detail in advance. Medical providers also need to pay close attention to diet and labs when following patient with history of bariatric surgery.