Acute Oxalate Nephropathy Induced by Dimethyl Oxalate: A Report of 3 Cases and Literature Review

Dimethyl oxalate is widely used in the manufacturing of dyes, resins, plastics, and pharmaceuticals. Dimethyl oxalate poisoning cases are rarely reported, despite their significant contact toxicity. Through the presentation of 3 case reports and a literature review, we underscore the clinicopathological features, diagnosis, management, and outcomes of kidney injury because of dimethyl oxalate poisoning. Our patients developed gastrointestinal symptoms and severe acute kidney injury following accidental exposure to dimethyl oxalate at their workplace. Kidney biopsies confirmed the diagnosis of acute oxalate nephropathy. The literature review indicated that dimethyl oxalate poisoning, which typically occurs through direct contact with its solid form or accidental inhalation of its gaseous state, should be considered in patients who present a clear history of exposure, gastrointestinal symptoms, and acute kidney injury. Acute oxalate nephropathy is characterized by crystallization and deposition of oxalate within the renal tubules, exhibiting distinct refractive properties when observed under polarized light. Renal replacement therapy, adequate hydration, and citrate administration facilitate the clearance of oxalic acid, and anti-inflammatory therapy can prevent the progression of kidney inflammation and promote tissue repair. In cases of this particular type of toxic nephropathy, most patients did not require maintenance dialysis following early intervention.