Acute renal failure after dietary change - a case report

The disease entity oxalate nephropathy (ON) is an uncommon but devastating cause of chronic kidney disease associated with the deposition of calcium oxalate crystals in the kidney tubules. The prognosis of ON is poor and targeted therapy is lacking.

Here, we report the case of a previously kidney-healthy 59-year-old White female presenting with acute renal failure (ARF) with enlarged kidneys after the consumption of one meal of freshly harvested Swiss chard as part of a longer-term vegetarian dietary change. Kidney biopsy indicated acute tubular damage with intratubular obstruction by oxalate crystal deposition and no evidence of chronic kidney damage or other relevant pathologies. Under conservative therapy and a low-oxalate diet, kidney function improved and the kidneys sonomorphologically returned to a normal size 4 weeks later. After continuing a low-oxalate diet for one year, a return to baseline eGFR was observed, which highlights the importance of nutritional intervention in such cases.

This case illustrates the importance of dietary patterns even in cases of an acute kidney failure. It raises relevant research questions, particularly regarding the threshold amount of oxalate crystal deposition in renal tissue that predicts clinically significant oxalate nephropathy.