title: Oxalate nephropathy associated with chronic pancreatitis.
abstract: OBJECTIVE
  Enteric overabsorption of oxalate may lead to hyperoxaluria and subsequent acute oxalate nephritis (AON). AON related to chronic pancreatitis is a rare and poorly described condition precluding early recognition and treatment.
  
  
  METHODS
  We collected the clinical characteristics, treatment, and renal outcome of 12 patients with chronic pancreatitis-associated AON followed in four French renal units.
  
  
  RESULTS
  Before AON, mild to moderate chronic kidney disease was present in all patients, diabetes mellitus in eight (insulin [n = 6]; oral antidiabetic drugs [n = 2]), and known chronic pancreatitis in only eight. At presentation, pancreas imaging showed gland atrophy/heterogeneity, Wirsung duct dilation, calcification, or pseudocyst. Renal findings consisted of rapidly progressive renal failure with tubulointerstitial profile. Acute modification of glomerular filtration preceded the AON (i.e., diarrhea and diuretics). Increase in urinary oxalate excretion was found in all tested patients and hypocalcemia in nine (<1.5 mmol/L in four patients). Renal biopsy showed diffuse crystal deposits, highly suggestive of oxalate crystals, with tubular necrosis and interstitial inflammatory cell infiltrates. Treatment consisted of pancreatic enzyme supplementation, oral calcium intake, and an oxalate-free diet in all patients and renal replacement therapy in five patients. After a median follow-up of 7 months, three of 12 patients reached end-stage renal disease.
  
  
  CONCLUSIONS
  AON is an under-recognized severe crystal-induced renal disease with features of tubulointerstitial nephritis that may occur in patients with a long history of chronic pancreatitis or reveal the pancreatic disease. Extrinsic triggering factors should be prevented.
authors: Service de Néphrologie et Immunologie Clinique, Hôpital de Rangueil, 1 avenue Jean Poulhès, TSA 50032, 31059 Toulouse Cedex 9, France.
authors: Claire
authors: C
authors: Cartery
authors: Stanislas
authors: S
authors: Faguer
authors: Alexandre
authors: A
authors: Karras
authors: Olivier
authors: O
authors: Cointault
authors: Louis
authors: L
authors: Buscail
authors: Anne
authors: A
authors: Modesto
authors: David
authors: D
authors: Ribes
authors: Lionel
authors: L
authors: Rostaing
authors: Dominique
authors: D
authors: Chauveau
authors: Patrick
authors: P
authors: Giraud
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002129:Calcium Oxalate / Q000378:metabolism*; D018450:Disease Progression; D005260:Female; D005602:France; D005919:Glomerular Filtration Rate; D006801:Humans; D006959:Hyperoxaluria / Q000209:etiology* / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D007668:Kidney / Q000378:metabolism* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009395:Nephritis, Interstitial / Q000209:etiology* / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D050500:Pancreatitis, Chronic / Q000150:complications* / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D051437:Renal Insufficiency / Q000209:etiology* / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002129:Calcium Oxalate