Limits...
Vitamin C-induced hyperoxaluria causing reversible tubulointerstitial nephritis and chronic renal failure: a case report.

Rathi S, Kern W, Lau K - J Med Case Rep (2007)

Bottom Line: He was hemodialysed 6 times to remove excess oxalate.Two weeks off vitamin C, his creatinine spontaneously fell to 3.1 mg/dL.Three months later, on low oxalate diet and 100 mg vitamin B6, urine oxalate to creatinine ratio decreased from 0.084 to 0.02 (normal < 0.035), while creatinine fell and stayed at 1.8 mg/dL. 1) High-dose vitamin C can induce hyperoxaluric nephropathy and progressive renal failure, especially if aggravated by diarrhea, oxalate-rich diet, metabolic acidosis, and dehydration. 2) The diagnosis should be suspected in unexplained renal insufficiency when associated with these risk factors. 3) Since prompt treatment could avert end-stage renal disease, we recommend monitoring urinary oxalate in patients on high-dose vitamin C and renal biopsy if necessary.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medicine, The University of Oklahoma Health Sciences Center, 1100 N, Lindsay, Oklahoma City, OK 73104, USA. kai-lau@ouhsc.edu.

ABSTRACT

Unlabelled: Vitamin C is a precursor of oxalate and promoter of its absorption, potentially causing hyperoxaluria. Malabsorption causes Calcium (Ca) chelation with fatty acids, producing enteric hyperoxaluria.

Case: A 73-year-old man with both risk factors was hospitalized with serum creatinine of 8.4 mg/dL (versus 1.2 mg/dL four months earlier) (normal 0.6-1.3 mg/dL). Given his oxalate-rich diet, chronic diarrhea, and daily 680 mg vitamin C and furosemide, we postulated Ca oxalate-induced nephropathy, a diagnosis confirmed by documenting hyperoxaluria, and finding of diffuse intraluminal crystals and extensive interstitial fibrosis on biopsy. He was hemodialysed 6 times to remove excess oxalate. Two weeks off vitamin C, his creatinine spontaneously fell to 3.1 mg/dL. Three months later, on low oxalate diet and 100 mg vitamin B6, urine oxalate to creatinine ratio decreased from 0.084 to 0.02 (normal < 0.035), while creatinine fell and stayed at 1.8 mg/dL.

Conclusion: 1) High-dose vitamin C can induce hyperoxaluric nephropathy and progressive renal failure, especially if aggravated by diarrhea, oxalate-rich diet, metabolic acidosis, and dehydration. 2) The diagnosis should be suspected in unexplained renal insufficiency when associated with these risk factors. 3) Since prompt treatment could avert end-stage renal disease, we recommend monitoring urinary oxalate in patients on high-dose vitamin C and renal biopsy if necessary.

No MeSH data available.


Related in: MedlinePlus

Serum creatinine, urine oxalate:creatinine ratio, and creatinine clearance vs. clinical timeline. (a) The chart shows the trend of serum creatinine (gray bars, with the values shown on the left axis), starting from a baseline of 1.2 mg/dL just over 4 months ago, gradually increasing up to 3.1 mg/dL 8 days ago, and rapidly increasing to 8.4 mg/dL on admission (day 0). The urine oxalate:creatinine ratio (red squares connected by lines, with values shown on the right axis) clearly shows hyperoxaluria at admission (0.084 at day 1, compared to a normal of 0.035). Vitamin C was stopped on day 4, and creatinine started improving after 2 days. (b) Renal function in terms of creatinine clearance (% of normal) is also shown.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2235877&req=5

Figure 1: Serum creatinine, urine oxalate:creatinine ratio, and creatinine clearance vs. clinical timeline. (a) The chart shows the trend of serum creatinine (gray bars, with the values shown on the left axis), starting from a baseline of 1.2 mg/dL just over 4 months ago, gradually increasing up to 3.1 mg/dL 8 days ago, and rapidly increasing to 8.4 mg/dL on admission (day 0). The urine oxalate:creatinine ratio (red squares connected by lines, with values shown on the right axis) clearly shows hyperoxaluria at admission (0.084 at day 1, compared to a normal of 0.035). Vitamin C was stopped on day 4, and creatinine started improving after 2 days. (b) Renal function in terms of creatinine clearance (% of normal) is also shown.

Mentions: A 73-year-old man was hospitalized for chronic diarrhea and serum creatinine of 8.4 mg/dL (vs. 1.2, 1.8, and 3.1, respectively, 4 months, 5 weeks, and 8 days earlier) (Fig 1a). He had a past history of chronic alcoholism, atrial fibrillation, hypertension, heart failure, and hypothyroidism (all resolved or controlled).


Vitamin C-induced hyperoxaluria causing reversible tubulointerstitial nephritis and chronic renal failure: a case report.

Rathi S, Kern W, Lau K - J Med Case Rep (2007)

Serum creatinine, urine oxalate:creatinine ratio, and creatinine clearance vs. clinical timeline. (a) The chart shows the trend of serum creatinine (gray bars, with the values shown on the left axis), starting from a baseline of 1.2 mg/dL just over 4 months ago, gradually increasing up to 3.1 mg/dL 8 days ago, and rapidly increasing to 8.4 mg/dL on admission (day 0). The urine oxalate:creatinine ratio (red squares connected by lines, with values shown on the right axis) clearly shows hyperoxaluria at admission (0.084 at day 1, compared to a normal of 0.035). Vitamin C was stopped on day 4, and creatinine started improving after 2 days. (b) Renal function in terms of creatinine clearance (% of normal) is also shown.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2235877&req=5

Figure 1: Serum creatinine, urine oxalate:creatinine ratio, and creatinine clearance vs. clinical timeline. (a) The chart shows the trend of serum creatinine (gray bars, with the values shown on the left axis), starting from a baseline of 1.2 mg/dL just over 4 months ago, gradually increasing up to 3.1 mg/dL 8 days ago, and rapidly increasing to 8.4 mg/dL on admission (day 0). The urine oxalate:creatinine ratio (red squares connected by lines, with values shown on the right axis) clearly shows hyperoxaluria at admission (0.084 at day 1, compared to a normal of 0.035). Vitamin C was stopped on day 4, and creatinine started improving after 2 days. (b) Renal function in terms of creatinine clearance (% of normal) is also shown.
Mentions: A 73-year-old man was hospitalized for chronic diarrhea and serum creatinine of 8.4 mg/dL (vs. 1.2, 1.8, and 3.1, respectively, 4 months, 5 weeks, and 8 days earlier) (Fig 1a). He had a past history of chronic alcoholism, atrial fibrillation, hypertension, heart failure, and hypothyroidism (all resolved or controlled).

Bottom Line: He was hemodialysed 6 times to remove excess oxalate.Two weeks off vitamin C, his creatinine spontaneously fell to 3.1 mg/dL.Three months later, on low oxalate diet and 100 mg vitamin B6, urine oxalate to creatinine ratio decreased from 0.084 to 0.02 (normal < 0.035), while creatinine fell and stayed at 1.8 mg/dL. 1) High-dose vitamin C can induce hyperoxaluric nephropathy and progressive renal failure, especially if aggravated by diarrhea, oxalate-rich diet, metabolic acidosis, and dehydration. 2) The diagnosis should be suspected in unexplained renal insufficiency when associated with these risk factors. 3) Since prompt treatment could avert end-stage renal disease, we recommend monitoring urinary oxalate in patients on high-dose vitamin C and renal biopsy if necessary.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medicine, The University of Oklahoma Health Sciences Center, 1100 N, Lindsay, Oklahoma City, OK 73104, USA. kai-lau@ouhsc.edu.

ABSTRACT

Unlabelled: Vitamin C is a precursor of oxalate and promoter of its absorption, potentially causing hyperoxaluria. Malabsorption causes Calcium (Ca) chelation with fatty acids, producing enteric hyperoxaluria.

Case: A 73-year-old man with both risk factors was hospitalized with serum creatinine of 8.4 mg/dL (versus 1.2 mg/dL four months earlier) (normal 0.6-1.3 mg/dL). Given his oxalate-rich diet, chronic diarrhea, and daily 680 mg vitamin C and furosemide, we postulated Ca oxalate-induced nephropathy, a diagnosis confirmed by documenting hyperoxaluria, and finding of diffuse intraluminal crystals and extensive interstitial fibrosis on biopsy. He was hemodialysed 6 times to remove excess oxalate. Two weeks off vitamin C, his creatinine spontaneously fell to 3.1 mg/dL. Three months later, on low oxalate diet and 100 mg vitamin B6, urine oxalate to creatinine ratio decreased from 0.084 to 0.02 (normal < 0.035), while creatinine fell and stayed at 1.8 mg/dL.

Conclusion: 1) High-dose vitamin C can induce hyperoxaluric nephropathy and progressive renal failure, especially if aggravated by diarrhea, oxalate-rich diet, metabolic acidosis, and dehydration. 2) The diagnosis should be suspected in unexplained renal insufficiency when associated with these risk factors. 3) Since prompt treatment could avert end-stage renal disease, we recommend monitoring urinary oxalate in patients on high-dose vitamin C and renal biopsy if necessary.

No MeSH data available.


Related in: MedlinePlus