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Secondary hyperoxaluria due to pancreatic insufficiency
D G L de Martines1, S Gianotten, J F M Wetzels
1Department of Nephrology, Radboud University Medical Centre, Nijmegen, the Netherlands.
The Netherlands Journal of Medicine
|December 10, 2019
Summary
Secondary hyperoxaluria can cause kidney injury in patients with exocrine pancreatic insufficiency. This condition leads to oxalate crystal buildup in the kidneys, impairing renal function.
Area of Science:
- Nephrology
- Gastroenterology
- Biochemistry
Background:
- Presents two cases of acute renal insufficiency in patients with exocrine pancreatic insufficiency.
- Exocrine pancreatic insufficiency was due to pancreaticoduodenectomy in one case and alcohol abuse in the other.
- Neither patient exhibited significant proteinuria or hematuria.
Observation:
- Renal biopsies revealed tubulopathy with widespread oxalate crystals.
- Oxalate crystals were characterized by birefringence under light microscopy.
- Patients presented with progressive kidney injury without typical signs like proteinuria or hematuria.
Findings:
- Reduced serum oxalate levels were observed after restricting dietary oxalate and administering oxalate-binding agents.
- Partial recovery of renal function was noted in both patients following treatment.
- Hyperoxaluria, caused by increased oxalate absorption due to impaired calcium binding in pancreatic insufficiency, leads to oxalate nephropathy.
Implications:
- Secondary hyperoxaluria is a significant cause of renal insufficiency.
- Considers the link between pancreatic insufficiency, surgery, inflammatory bowel disease, and oxalate nephropathy.
- Highlights the importance of considering secondary hyperoxaluria in patients with pancreatic insufficiency and kidney injury.
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