Hyperoxaluria and oxalosis
Hyperoxaluria occurs when you have too much oxalate in your urine. Oxalate is a natural chemical in your body, and it's also found in certain types of food. But too much oxalate in your urine can cause serious problems.Hyperoxaluria can be caused by inherited (genetic) disorders, an intestinal disease or eating too many oxalate-rich foods. Quick diagnosis and treatment of hyperoxaluria is important to the long-term health of your kidneys.Oxalosis happens after the kidneys fail in people who have primary and intestinal causes of hyperoxaluria, and excess oxalate builds up in the blood. This can lead to oxalate deposits in blood vessels, bones and body organs.
Commonly, kidney stones are the first sign of hyperoxaluria. Kidney stones are uncommon in childhood. Kidney stones that form in children and teenagers are likely to be caused by an underlying condition, such as hyperoxaluria. For this reason, all young people with kidney stones should have a thorough evaluation, including measurement of oxalate in the urine. Adults with recurrent kidney stones also should be evaluated for oxalate in the urine.Symptoms of a kidney stone can include the following:Severe or sudden abdominal or flank pain,Blood in the urine,Frequent urge to urinate,Pain when urinating,Fever and chills.Primary hyperoxaluria (PH) that goes untreated can eventually damage your kidneys. Over time your kidneys may stop working. For some people, this is the first sign of the disease.
Treatment will depend on the type, symptoms and severity of hyperoxaluria and how well you respond to treatment.Medications. Prescription doses of vitamin B-6 can be effective in reducing oxalate in the urine in some people with primary hyperoxaluria. Oral preparations of phosphates and citrate help prevent the formation of calcium oxalate crystals. Other medications, such as thiazide diuretics, also may be considered, depending on which other abnormalities are present in your urine.High fluid intake. If your kidneys are still functioning normally, your doctor will likely tell you to drink more water or other fluids. This flushes the kidneys, prevents oxalate crystal buildup and helps keep kidney stones from forming.Dietary changes. The effectiveness of diet will depend on the cause of increased levels of oxalate. Diet may include restricting foods high in oxalates, limiting salt, and decreasing animal protein and sugar (high fructose corn syrup). This may help to lower urinary oxalate in people with enteric hyperoxaluria or excess dietary intake. Dietary restrictions may not be as important for all people with primary hyperoxaluria. Follow the advice of your doctor.
Primary hyperoxaluria type 1 (PH1) is a rare genetic disorder characterized by allelic and clinical heterogeneity. We aim to describe the presentation and full single-center experience of the management of PH1 patients bearing the mutation described in our community (I244T mutation+polymorphism P11L). Since 1983, 12 patients with recurrent renal lithiasis have been diagnosed with PH1 and renal failure in the Canary Islands, Spain. Diagnostic confirmation was based on the presence of oxalosis in undecalcified bone or kidney allograft biopsy, reduced alanine:glyoxylate aminotransferase activity in liver biopsy, and blood DNA analysis. Patients underwent different treatment modalities depending on individual clinical circumstances and therapeutic possibilities at the time of diagnosis: hemodialysis, isolated kidney, simultaneous liver–kidney, or pre-emptive liver transplantation. In all cases, the presentation of advanced renal disease was relatively late (>13 years) and no cases were reported during lactancy or childhood. The eight patients treated with hemodialysis or isolated kidney transplantation showed unfavorable evolution leading to death over a variable period of time. In contrast, the four patients undergoing liver transplantation (three liver+kidney and one pre-emptive liver alone) showed favorable long-term allograft and patient survival (up to 12 years follow-up). In conclusion, in this PH1 population, all bearing the I244T mutation, the development of end-stage renal disease was distinctive during late adolescence or adulthood. Our long-term results support pre-emptive liver transplantation at early stages of renal failure, and kidney–liver transplantation for those with advanced renal disease.