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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

Pathophysiology and management of hyperoxaluric nephropathy.
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Figure 3: Pathophysiology and management of hyperoxaluric nephropathy.

Mentions: In our patient, intratubular luminal precipitation of Ca oxalate was promoted by four pathogenic factors (Fig 3): (1) high urine specific gravity (due to diarrhea-induced dehydration), (2) hyperoxaluria from all three potentiating mechanisms (oxalate-rich diet, 680 mg daily vitamin C, and possible malabsorption), (3) relative hypercalciuria (due to furosemide, chronic metabolic acidosis, and hypercalcemia, caused by CaCO3 pills and vitamin A and D), and (4) hypocitraturia (due to metabolic acidosis, initially from chronic diarrhea and later aggravated by progressive renal failure).


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)

Pathophysiology and management of hyperoxaluric nephropathy.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Pathophysiology and management of hyperoxaluric nephropathy.
Mentions: In our patient, intratubular luminal precipitation of Ca oxalate was promoted by four pathogenic factors (Fig 3): (1) high urine specific gravity (due to diarrhea-induced dehydration), (2) hyperoxaluria from all three potentiating mechanisms (oxalate-rich diet, 680 mg daily vitamin C, and possible malabsorption), (3) relative hypercalciuria (due to furosemide, chronic metabolic acidosis, and hypercalcemia, caused by CaCO3 pills and vitamin A and D), and (4) hypocitraturia (due to metabolic acidosis, initially from chronic diarrhea and later aggravated by progressive renal failure).

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