title: Acute oxalate nephropathy following kidney transplantation: Report of three cases.
abstract: Calcium oxalate (CaOx) crystal deposition is a common finding immediately after kidney transplantation. However, small depositions of CaOx could be benign while extensive depositions lead to poor graft outcome. Here we report three cases with end-stage renal disease (ESRD), bilateral nephrolithiasis, and unknown diagnosis of primary hyperoxaluria (PH) who underwent a renal transplant and experienced an early-onset graft failure. Although an acute rejection was suspected, renal allograft biopsies and subsequent allograft nephrectomies showed extensive CaOx deposition, which raised a suspicion of PH. Even though increased urinary excretion of CaOx was found in all patients, this diagnosis could be confirmed with further tests including genetic study and metabolic assay. In conclusion, massive CaOx deposition in kidney allograft is an important cause of poor allograft survival and needs special management. Furthermore, our cases suggest patients with ESRD and a history of nephrolithiasis should be screened for elevated urinary oxalate excretion and rule out of PH.
authors.affiliation: Department of Pathology, Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran ; Department of Nephrology, Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Diana
authors.initials: D
authors.lastname: Taheri
authors.affiliation: Department of Pediatric Nephrology, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Alaleh
authors.initials: A
authors.lastname: Gheissari
authors.affiliation: Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Pooria
authors.initials: P
authors.lastname: Shaabani
authors.affiliation: Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Seyed Reza
authors.initials: SR
authors.lastname: Tabibian
authors.affiliation: Department of Nephrology, Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mojgan
authors.initials: M
authors.lastname: Mortazavi
authors.affiliation: Department of Nephrology, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Shiva
authors.initials: S
authors.lastname: Seirafian
authors.affiliation: Department of Pediatric Nephrology, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Merrikhi
authors.affiliation: Department of Surgery, School of Medicine, Islamic Azad University, Najaf Abad Branch, Isfahan, Iran.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Fesharakizadeh
authors.affiliation: Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Shahaboddin
authors.initials: S
authors.lastname: Dolatkhah
keywords: Acute oxalate nephropathy; calcium oxalate deposition; kidney transplantation; nephrocalcinosis; primary hyperoxaluria