Cuvelier Charles, Goffin Eric, Cosyns Jean-Pierre, Wauthier Michel, de Strihou Charles van Ypersele
Department of Nephrology, Cliniques Universitaires St. Luc, Brussels, Belgium.
Am J Kidney Dis. 2002 Jul;40(1):E3. doi: 10.1053/ajkd.2002.33934.
A 37-year-old patient underwent two successive renal transplantations 7 months apart. He remained dialysis dependent. Early biopsy of both grafts revealed widespread calcium oxalate deposition suggestive of acute oxalate nephropathy. Several causes of oxalate nephropathy, including primary oxalosis and an increased intake of oxalic acid precursors, were excluded. Two years later, the identification of steatorrhea with radiologic signs of chronic pancreatitis led to the hypothesis of enteric hyperoxaluria. Surprisingly, 11 months after the second transplantation, graft function improved progressively allowing interruption of dialysis. Three years later, renal function is stable. The causes and prevention of acute oxalate-induced graft failure are highlighted. Subclinical evidence of enteric hyperoxaluria should be looked for and appropriate therapy instituted as early as possible. The possibility of a late recovery of renal function warrants attentive patience from attending physicians.
一名37岁的患者在相隔7个月的时间里连续接受了两次肾移植。他仍依赖透析。对两个移植肾的早期活检显示广泛的草酸钙沉积，提示急性草酸肾病。排除了草酸肾病的几种病因，包括原发性草酸盐血症和草酸前体摄入增加。两年后，发现脂肪泻伴有慢性胰腺炎的放射学征象，从而提出了肠源性高草酸尿症的假说。令人惊讶的是，在第二次移植后11个月，移植肾功能逐渐改善，使得透析得以中断。三年后，肾功能稳定。强调了急性草酸诱导的移植肾失败的病因及预防。应尽早寻找肠源性高草酸尿症的亚临床证据并采取适当治疗。肾功能晚期恢复的可能性需要主治医生给予耐心关注。
