Enteric hyperoxaluria: a hidden cause of early renal graft failure in two successive transplants: spontaneous late graft recovery.
A 37-year-old patient underwent two successive renal transplantations 7 months apart. He remained dialysis dependent. Early biopsy of both grafts revealed widespread calcium oxalate deposition suggestive of acute oxalate nephropathy. Several causes of oxalate nephropathy, including primary oxalosis and an increased intake of oxalic acid precursors, were excluded. Two years later, the identification of steatorrhea with radiologic signs of chronic pancreatitis led to the hypothesis of enteric hyperoxaluria. Surprisingly, 11 months after the second transplantation, graft function improved progressively allowing interruption of dialysis. Three years later, renal function is stable. The causes and prevention of acute oxalate-induced graft failure are highlighted. Subclinical evidence of enteric hyperoxaluria should be looked for and appropriate therapy instituted as early as possible. The possibility of a late recovery of renal function warrants attentive patience from attending physicians.
Cuvelier
Charles
C
Department of Nephrology, Cliniques Universitaires St. Luc, Brussels, Belgium.
Goffin
Eric
E
Cosyns
Jean-Pierre
JP
Wauthier
Michel
M
de Strihou
Charles van Ypersele
Cv
D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy* / Q000652:urine; D000328:Adult; D002446:Celiac Disease / Q000209:etiology; D002908:Chronic Disease; D006801:Humans; D006959:Hyperoxaluria / Q000150:complications*; D007668:Kidney / Q000737:chemistry / Q000473:pathology; D016030:Kidney Transplantation / Q000473:pathology*; D007713:Klinefelter Syndrome / Q000150:complications; D008297:Male; D010070:Oxalates / Q000009:adverse effects / Q000032:analysis / Q000652:urine*; D010195:Pancreatitis / Q000209:etiology; D012086:Reoperation; D017211:Treatment Failure; D016896:Treatment Outcome
D010070:Oxalates