Acute oxalate nephropathy causing late renal transplant dysfunction due to enteric hyperoxaluria

Area of Science:

• Nephrology
• Gastroenterology
• Transplantation

Background:

• Calcium oxalate (CaOx) deposition is a significant cause of kidney allograft injury.
• Enteric hyperoxaluria, often linked to malabsorption, can lead to CaOx nephropathy.
• Pancreatic insufficiency can result in fat malabsorption and subsequent enteric hyperoxaluria.

Observation:

• A kidney transplant recipient presented with late graft dysfunction and diarrhea.
• The patient had a history of noncompliance with pancreatic enzyme replacement therapy.
• This led to a diagnosis of enteric hyperoxaluria secondary to pancreatic insufficiency.

Findings:

• Acute oxalate nephropathy was diagnosed in the renal allograft.
• Treatment involved hemodialysis, a low-fat, low-oxalate diet, and pancreatic enzyme supplementation.
• The patient's graft function recovered following the intervention.

Implications:

• Fat malabsorption leading to enteric hyperoxaluria should be considered in renal transplant recipients with diarrhea and graft dysfunction.
• Ensuring compliance with pancreatic enzyme replacement therapy is crucial for patients with pancreatic insufficiency.
• Early recognition and management of enteric hyperoxaluria can prevent or reverse allograft dysfunction.