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Acute renal failure, microangiopathic haemolytic anemia, and secondary oxalosis in a young female patient.

Stepien KM, Prinsloo P, Hitch T, McCulloch TA, Sims R - Int J Nephrol (2011)

Bottom Line: The patient had been taking large doses (>1100 mg daily) of vitamin C for many months.She also gave a history of sclerotherapy using injections of an ethylene glycol derivative for superficial leg veins.She has now discontinued sclerotherapy and vitamin supplementation.

View Article: PubMed Central - PubMed

Affiliation: Clinical Pathology Department, Nottingham University Hospitals Trust, Nottingham NG5 1PB, UK.

ABSTRACT
A 29-year old female presented with a one-week history of vomiting, diarrhoea, abdominal pain, and headache. On admission, she had acute renal failure requiring dialysis. Tests revealed a hemolytic anemia with thrombocytopenia. An initial diagnosis of thrombotic thrombocytopenic microangiopathy was made and plasma exchange was instigated. However, renal biopsy did not show thrombotic microangiopathy but instead revealed acute kidney injury with mild tubulointerstitial nephritis and numerous oxalate crystals, predominantly in the distal tubules. The patient had been taking large doses (>1100 mg daily) of vitamin C for many months. She also gave a history of sclerotherapy using injections of an ethylene glycol derivative for superficial leg veins. The patient completed five sessions of plasma exchange and was able to discontinue dialysis. She eventually achieved full renal recovery. She has now discontinued sclerotherapy and vitamin supplementation.

No MeSH data available.


Related in: MedlinePlus

(a) Oxalate crystals (arrows) in tubular epithelium and lumena under normal light (Original magnification X400). (b) Calcium oxalate crystals (⋆) in tubular epithelium and lumena under polarised light (Original magnification X400).
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fig2: (a) Oxalate crystals (arrows) in tubular epithelium and lumena under normal light (Original magnification X400). (b) Calcium oxalate crystals (⋆) in tubular epithelium and lumena under polarised light (Original magnification X400).

Mentions: Renal biopsy could not be performed until four days into the treatment course of plasma exchange. No evidence of thrombotic microangiopathy was present. The biopsy showed an acute tubulointerstitial pathology characterised by focal, but marked, acute tubular injury (Figure 1(a)), with cell sloughing and a mild tubulointerstitial nephritis (Figure 1(b)). Additionally, the presence of numerous oxalate crystals within both the tubular lumina and the tubular epithelial cells was confirmed under polarized light (Figures 2(a) and 2(b)). The distal tubules appeared more affected than the proximal ones. There was no evidence of a glomerulonephritis or any significant vascular pathology.


Acute renal failure, microangiopathic haemolytic anemia, and secondary oxalosis in a young female patient.

Stepien KM, Prinsloo P, Hitch T, McCulloch TA, Sims R - Int J Nephrol (2011)

(a) Oxalate crystals (arrows) in tubular epithelium and lumena under normal light (Original magnification X400). (b) Calcium oxalate crystals (⋆) in tubular epithelium and lumena under polarised light (Original magnification X400).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3140202&req=5

fig2: (a) Oxalate crystals (arrows) in tubular epithelium and lumena under normal light (Original magnification X400). (b) Calcium oxalate crystals (⋆) in tubular epithelium and lumena under polarised light (Original magnification X400).
Mentions: Renal biopsy could not be performed until four days into the treatment course of plasma exchange. No evidence of thrombotic microangiopathy was present. The biopsy showed an acute tubulointerstitial pathology characterised by focal, but marked, acute tubular injury (Figure 1(a)), with cell sloughing and a mild tubulointerstitial nephritis (Figure 1(b)). Additionally, the presence of numerous oxalate crystals within both the tubular lumina and the tubular epithelial cells was confirmed under polarized light (Figures 2(a) and 2(b)). The distal tubules appeared more affected than the proximal ones. There was no evidence of a glomerulonephritis or any significant vascular pathology.

Bottom Line: The patient had been taking large doses (>1100 mg daily) of vitamin C for many months.She also gave a history of sclerotherapy using injections of an ethylene glycol derivative for superficial leg veins.She has now discontinued sclerotherapy and vitamin supplementation.

View Article: PubMed Central - PubMed

Affiliation: Clinical Pathology Department, Nottingham University Hospitals Trust, Nottingham NG5 1PB, UK.

ABSTRACT
A 29-year old female presented with a one-week history of vomiting, diarrhoea, abdominal pain, and headache. On admission, she had acute renal failure requiring dialysis. Tests revealed a hemolytic anemia with thrombocytopenia. An initial diagnosis of thrombotic thrombocytopenic microangiopathy was made and plasma exchange was instigated. However, renal biopsy did not show thrombotic microangiopathy but instead revealed acute kidney injury with mild tubulointerstitial nephritis and numerous oxalate crystals, predominantly in the distal tubules. The patient had been taking large doses (>1100 mg daily) of vitamin C for many months. She also gave a history of sclerotherapy using injections of an ethylene glycol derivative for superficial leg veins. The patient completed five sessions of plasma exchange and was able to discontinue dialysis. She eventually achieved full renal recovery. She has now discontinued sclerotherapy and vitamin supplementation.

No MeSH data available.


Related in: MedlinePlus