Parasuraman Ravi, L Zhang Ping, Samarapungavan Dilip, Pothugunta Krishna, Reddy Gampala, Rocher Leslie, Dumler Francis, Raofi Vandad, Cohn Steven, Koffron Alan
Division of Nephrology and Transplantation, William-Beaumont Hospital, Royal Oak, MI 48037, USA ; Kidney Transplant Outreach Program, William-Beaumont Hospital, Royal Oak, MI 48037, USA ; Oakland University, William Beaumont School of Medicine, Royal Oak, MI 48037, USA.
Case Rep Transplant. 2011;2011:876906. doi: 10.1155/2011/876906. Epub 2011 Sep 28.
Primary nonfunction (PNF) accounts for 0.6 to 8% of renal allograft failure, and the focus on causes of PNF has changed from rejection to other causes. Calcium oxalate (CaOx) deposition is common in early allograft biopsies, and it contributes in moderate intensity to higher incidence of acute tubular necrosis and poor graft survival. A-49-year old male with ESRD secondary to polycystic kidney disease underwent extended criteria donor kidney transplantation. Posttransplant, patient developed delayed graft function (DGF), and the biopsy showed moderately intense CaOx deposition that persisted on subsequent biopsies for 16 weeks, eventually resulting in PNF. The serum oxalate level was 3 times more than normal at 85 μmol/L (normal <27 μmol/L). Allograft nephrectomy showed massive aggregates of CaOx crystal deposition in renal collecting system. In conclusion, acute oxalate nephropathy should be considered in the differential diagnosis of DGF since optimal management could change the outcome of the allograft.
原发性无功能（PNF）占肾移植失败的0.6%至8%，并且对PNF病因的关注已从排斥反应转向其他原因。草酸钙（CaOx）沉积在早期移植肾活检中很常见，并且它在中等程度上导致急性肾小管坏死的发生率较高以及移植肾存活率较低。一名49岁因多囊肾病继发终末期肾病（ESRD）的男性接受了扩大标准供体肾移植。移植后，患者出现移植肾功能延迟恢复（DGF），活检显示有中等强度的CaOx沉积，在随后的16周活检中持续存在，最终导致PNF。血清草酸盐水平为85μmol/L，是正常水平的3倍（正常<27μmol/L）。移植肾切除显示肾集合系统中有大量CaOx晶体沉积聚集。总之，在DGF的鉴别诊断中应考虑急性草酸肾病，因为最佳治疗可能会改变移植肾的结局。
