Crystalline Bone Marrow in Systemic Oxalosis
KeywordsOxalate Glyoxylate Nephrolithiasis Calcium Oxalate Urine Oxalate
Primary hyperoxaluria is a rare, autosomal recessive disorder of hepatic glyoxylate metabolism resulting in overproduction of oxalate.1 Oxalate nephropathy results in renal failure, which leads to a further increase in the plasma concentration of oxalate. Calcium oxalate can then deposit into a wide array of tissues including bone, retina, peripheral nerves, arterial media, and the heart.2 For some patients, treatment with pyridoxine to reduce urine oxalate levels may be beneficial, though liver and kidney transplantation is often required.3
Both kidney transplants had taken place overseas, and the patient’s initial renal failure and first transplant failure were attributed to obstructive nephropathy from renal calculi. The second transplant loss was from rejection related to a reduction of immunosuppression, though biopsy revealed deposition of calcium oxalate crystals as well.
Conflict of Interest
Dr. Gaggar reports stock ownership and current employment with Gilead Sciences.