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Renal oxalate stones in children with Zellweger spectrum disorders
1Department of Surgery, Division of Urology, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
Insights
Zellweger spectrum disorders (ZSDs) can cause kidney problems like oxalate stones. Early screening for hyperoxaluria in ZSD patients is crucial to prevent renal damage.
Area of Science:
- Biochemistry
- Genetics
- Pediatrics
Background:
- Peroxisomal biogenesis disorders (PBDs) arise from PEX gene defects, with Zellweger spectrum disorders (ZSDs) being the most common subgroup.
- ZSDs manifest in neonatal, adolescent, or adult phenotypes, exhibiting variable clinical severity and metabolic abnormalities due to impaired peroxisomal function.
Observation:
- A case study identified oxalate renal stones in a patient diagnosed with ZSD.
- The patient presented with hyperoxaluria and hyperglycolic aciduria, indicating a significant urinary oxalate load.
Findings:
- Radiological evaluation confirmed renal involvement, including urolithiasis (kidney stones) and nephrocalcinosis (kidney calcification).
- Assessment of urinary oxalate and glycolate excretion correlated with the observed clinical signs of hyperoxaluria.
Implications:
- The findings highlight the importance of screening ZSD patients for urinary stones and hyperoxaluria using urinalysis and ultrasonography.
- Early detection and intervention are recommended to mitigate renal damage and improve patient outcomes in ZSD.
Abstract:
Peroxisomal biogenesis disorders due to PEX gene defects are classified into many subgroups, of which Zellweger spectrum disorders (ZSDs) represent the major subgroup. The ZSDs are clinical and biochemical disorders divided into three phenotypes: neonatal, adolescence, or adult. Clinical presentations vary with severity of the condition. Metabolic abnormalities occur due to functional peroxisomal defects that could be detected in blood and urine. No cure or definitive management exists to date; only supportive and palliative measures are applied to prevent worse sequelae. We experienced a case of oxalate renal stones in a patient with ZSD. This patient had hyperoxaluria and hyperglycolic aciduria with clinically associated clues that correlate with urinary oxalate load. Urinary oxalate and glycolate excretion were assessed. Radiological workup revealed renal involvement with urolithiasis and nephrocalcinosis. Urinalysis and ultrasonography for stones and hyperoxaluria should be used to screen patients with ZSD for early intervention to prevent renal damage.
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