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Accelerated Oxalosis Contributing to Delayed Graft Function after Renal Transplantation

Hyperoxaluria is an important and underrecognized cause for allograft dysfunction and loss after transplantation. It is potentially treatable if recognized in a timely fashion. Research is ongoing to expand the array of therapeutic options available to treat this. We present a case of a 59-year-old...

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Autores principales: Kelly, Yvelynne P., Weins, Astrid, Yeung, Melissa Y.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6452533/
https://www.ncbi.nlm.nih.gov/pubmed/31019830
http://dx.doi.org/10.1155/2019/8942062
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author Kelly, Yvelynne P.
Weins, Astrid
Yeung, Melissa Y.
author_facet Kelly, Yvelynne P.
Weins, Astrid
Yeung, Melissa Y.
author_sort Kelly, Yvelynne P.
collection PubMed
description Hyperoxaluria is an important and underrecognized cause for allograft dysfunction and loss after transplantation. It is potentially treatable if recognized in a timely fashion. Research is ongoing to expand the array of therapeutic options available to treat this. We present a case of a 59-year-old gentleman who underwent deceased donor renal transplantation that was complicated by delayed graft function necessitating continuation of renal replacement therapy. His initial biopsy showed extensive acute tubular necrosis with associated peritubular capillaritis and interstitial nephritis and oxalate crystals in several tubules. Despite receiving methylprednisolone to treat moderate acute cellular rejection, he remained dialysis dependent with minimal urine output. An interval renal allograft biopsy revealed residual acute tubular necrosis with extensive oxalate crystals now visible in many tubules. His plasma oxalate level was concurrently elevated to 19.3 μmol/L (reference range ≤ 1.9 μmol/L). He commenced calcium citrate to manage his hyperoxaluria and ultimately became dialysis independent at 3 weeks after transplantation. This case provides an important example of accelerated oxalate nephropathy as an underappreciated contributor to delayed graft function after renal transplantation. Our accompanying discussion provides an update on current therapeutic measures for managing this challenging condition.
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spelling pubmed-64525332019-04-24 Accelerated Oxalosis Contributing to Delayed Graft Function after Renal Transplantation Kelly, Yvelynne P. Weins, Astrid Yeung, Melissa Y. Case Rep Transplant Case Report Hyperoxaluria is an important and underrecognized cause for allograft dysfunction and loss after transplantation. It is potentially treatable if recognized in a timely fashion. Research is ongoing to expand the array of therapeutic options available to treat this. We present a case of a 59-year-old gentleman who underwent deceased donor renal transplantation that was complicated by delayed graft function necessitating continuation of renal replacement therapy. His initial biopsy showed extensive acute tubular necrosis with associated peritubular capillaritis and interstitial nephritis and oxalate crystals in several tubules. Despite receiving methylprednisolone to treat moderate acute cellular rejection, he remained dialysis dependent with minimal urine output. An interval renal allograft biopsy revealed residual acute tubular necrosis with extensive oxalate crystals now visible in many tubules. His plasma oxalate level was concurrently elevated to 19.3 μmol/L (reference range ≤ 1.9 μmol/L). He commenced calcium citrate to manage his hyperoxaluria and ultimately became dialysis independent at 3 weeks after transplantation. This case provides an important example of accelerated oxalate nephropathy as an underappreciated contributor to delayed graft function after renal transplantation. Our accompanying discussion provides an update on current therapeutic measures for managing this challenging condition. Hindawi 2019-03-25 /pmc/articles/PMC6452533/ /pubmed/31019830 http://dx.doi.org/10.1155/2019/8942062 Text en Copyright © 2019 Yvelynne P. Kelly et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Kelly, Yvelynne P.
Weins, Astrid
Yeung, Melissa Y.
Accelerated Oxalosis Contributing to Delayed Graft Function after Renal Transplantation
title Accelerated Oxalosis Contributing to Delayed Graft Function after Renal Transplantation
title_full Accelerated Oxalosis Contributing to Delayed Graft Function after Renal Transplantation
title_fullStr Accelerated Oxalosis Contributing to Delayed Graft Function after Renal Transplantation
title_full_unstemmed Accelerated Oxalosis Contributing to Delayed Graft Function after Renal Transplantation
title_short Accelerated Oxalosis Contributing to Delayed Graft Function after Renal Transplantation
title_sort accelerated oxalosis contributing to delayed graft function after renal transplantation
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6452533/
https://www.ncbi.nlm.nih.gov/pubmed/31019830
http://dx.doi.org/10.1155/2019/8942062
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