Service de Néphrologie et Immunologie Clinique, Hôpital de Rangueil, 1 avenue Jean Poulhès, TSA 50032, 31059 Toulouse Cedex 9, France.
Clin J Am Soc Nephrol. 2011 Aug;6(8):1895-902. doi: 10.2215/CJN.00010111. Epub 2011 Jul 7.
Enteric overabsorption of oxalate may lead to hyperoxaluria and subsequent acute oxalate nephritis (AON). AON related to chronic pancreatitis is a rare and poorly described condition precluding early recognition and treatment.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We collected the clinical characteristics, treatment, and renal outcome of 12 patients with chronic pancreatitis-associated AON followed in four French renal units.
Before AON, mild to moderate chronic kidney disease was present in all patients, diabetes mellitus in eight (insulin [n = 6]; oral antidiabetic drugs [n = 2]), and known chronic pancreatitis in only eight. At presentation, pancreas imaging showed gland atrophy/heterogeneity, Wirsung duct dilation, calcification, or pseudocyst. Renal findings consisted of rapidly progressive renal failure with tubulointerstitial profile. Acute modification of glomerular filtration preceded the AON (i.e., diarrhea and diuretics). Increase in urinary oxalate excretion was found in all tested patients and hypocalcemia in nine (<1.5 mmol/L in four patients). Renal biopsy showed diffuse crystal deposits, highly suggestive of oxalate crystals, with tubular necrosis and interstitial inflammatory cell infiltrates. Treatment consisted of pancreatic enzyme supplementation, oral calcium intake, and an oxalate-free diet in all patients and renal replacement therapy in five patients. After a median follow-up of 7 months, three of 12 patients reached end-stage renal disease.
AON is an under-recognized severe crystal-induced renal disease with features of tubulointerstitial nephritis that may occur in patients with a long history of chronic pancreatitis or reveal the pancreatic disease. Extrinsic triggering factors should be prevented.
草酸盐的肠道过度吸收可能导致高草酸尿症和随后的急性草酸肾病（AON）。与慢性胰腺炎相关的 AON 是一种罕见且描述不佳的疾病，难以早期识别和治疗。
设计、设置、参与者和测量：我们收集了在法国四个肾脏单位接受治疗的 12 例慢性胰腺炎相关 AON 患者的临床特征、治疗和肾脏结局。
在 AON 之前，所有患者均存在轻至中度慢性肾脏病，8 例患者患有糖尿病（胰岛素[6 例]；口服降糖药[2 例]），仅 8 例患者已知患有慢性胰腺炎。就诊时，胰腺影像学显示腺体萎缩/异质性、Wirsung 管扩张、钙化或假性囊肿。肾脏表现为快速进展性肾衰竭，伴有肾小管间质性表现。AON 之前发现肾小球滤过率急性改变（即腹泻和利尿剂）。所有检测患者的尿草酸盐排泄均增加，9 例患者血钙降低（4 例患者血钙<1.5mmol/L）。肾脏活检显示弥漫性晶体沉积，高度提示为草酸钙晶体，伴有肾小管坏死和间质炎症细胞浸润。所有患者均接受胰腺酶补充、口服钙摄入和无草酸盐饮食治疗，5 例患者接受肾脏替代治疗。在中位随访 7 个月后，12 例患者中有 3 例进入终末期肾病。
AON 是一种严重的晶体诱导性肾脏疾病，认识不足，具有肾小管间质性肾炎的特征，可能发生在慢性胰腺炎病史较长的患者中，或提示胰腺疾病。应预防外在触发因素。
