title: Primary hyperoxaluria--the German experience.
abstract: BACKGROUND
  Primary hyperoxaluria (PH) is a heterogeneous disease with variable age of onset and inconsistent progression into renal failure (ESRF).
  
  
  OBJECTIVE
  In 1994 we initiated a survey within our Pediatric Nephrology working group to ascertain epidemiologic data and current practices. Updates were performed in 2000 and 2004.
  
  
  RESULTS
  Diagnosis of PH was made in 65 patients (42 with PH type I, 3 with PH type II, 12 unclassified and 8 reported dead), which suggests a minimum prevalence of 0.7 per 1 million of the population. First symptoms were urolithiasis, nephrocalcinosis, urinary tract infection or hematuria. Diagnosis was often delayed and was made only in ESRF in 11% of patients. Measurement of urine metabolites or plasma oxalate in ESRF was performed in 76 and 57%, respectively. Determination of enzyme activity in liver biopsy (55% overall) and mutation analysis have increasingly been performed since 2000 (84.2 and 51%). Treatment included high fluid intake, pyridoxine, citrate and magnesium preparations. Pyridoxine response was reported in 21% of patients. No genotype/phenotype correlation was seen. Most patients (39) do not require renal replacement therapy, 5 patients receive chronic hemodialysis. Preemptive liver (n = 5) and combined liver-kidney transplantation (n = 9) were the preferred transplantation procedures.
  
  
  CONCLUSIONS
  Despite increasing knowledge and awareness, diagnosis of PH is still too often delayed and diagnosis only made in ESRF. Most German patients, however, do currently not require renal replacement therapy. Genotype/phenotype correlations were not found. Combined liver kidney transplantation is the preferred procedure, but has its specific risks. Additional treatment options are clearly needed.
authors.affiliation: Division of Pediatric Nephrology, Children's Hospital Cologne, University of Cologne, Cologne, Germany. bernd.hoppe@uk-koeln.de
authors.forename: Bernd
authors.initials: B
authors.lastname: Hoppe
authors.forename: Kay
authors.initials: K
authors.lastname: Latta
authors.forename: Christian
authors.initials: C
authors.lastname: von Schnakenburg
authors.forename: Markus J
authors.initials: MJ
authors.lastname: Kemper
mesh_terms: D019343:Citric Acid / Q000627:therapeutic use; D005440:Fluid Therapy; D005858:Germany / Q000453:epidemiology; D006801:Humans; D006960:Hyperoxaluria, Primary / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D007676:Kidney Failure, Chronic / Q000209:etiology; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008274:Magnesium / Q000627:therapeutic use; D009398:Nephrology / Q000379:methods; D010372:Pediatrics / Q000379:methods; D015995:Prevalence; D011736:Pyridoxine / Q000627:therapeutic use; D006435:Renal Dialysis; D013997:Time Factors
chemical_list: D019343:Citric Acid; D008274:Magnesium; D011736:Pyridoxine