SYNOPSIS Two patients, aged 66 and 62 years, are described who suffered from unilateral anuria and contralateral stone formation due to primary oxalosis. The diagnosis was established by microscopical examination of necropsy material in the first patient and by renal biopsy in the second and was confirmed by chemical and x-ray investigation of tissues and calculi. The sequence of events leading to the rather sudden precipitation of oxalate in the tissues is discussed, and a tentative explanation for the unilateral anuria is offered.
CASE 1A 66-year old stock farmer was admitted to the hospital on 6 March 1963, with complaints of lassitude, dyspnoea, pallor, shooting pains in the legs, and dysuria. He had been in good health until 1947, when an operation for left-sided kidney stones was performed. Since that time he had occasionally suffered from renal colic, haematuria, and passage of grit with the urine.His two daughters, brother, and sister were healthy; his mother had died of a stroke. In 1961 a medical examination showed a slight proteinuria and a normal plasma urea level of 15 mg./100 ml. The patient was a pale man with a deep, sighing respiration. Blood pressure was 130/80 mm.Hg. The temperature was normal. The tongue was dry and there was a stomatitis. The examination of heart, lungs, and abdomen did not show any abnormalities. Below the groins no pulsation of the arteries of the legs could be felt, while the oscillometer showed only minimal excursions.The daily volume of urine was 350-700 ml., with a proteinuria of 2 5%. The sediment contained erythrocytes and a few leucocytes but no crystals. Culture showed enterococcus 2-104 per ml. Haemoglobin was 8-9 g./100 ml., R.B.C.s 2,800,000, W.B.C.s 13,100, E.S.R. 45 mm. after one hour; urea 640 mg./100 ml., creatinine 35 mg./100 ml., Na 124 mEq./l., K 7-3 mEq./l., Cl 91 mEq./I., bicarbonate 4-8 mEq./l., Ca 4 0 mEq./l., P 9-1 mEq./l., uric acid 9-4 mg./100 ml., alkaline phosphatase 3-6 units/100 ml. (King and Armstrong method).The electrocardiogram showed small R-waves in lead V2. A calculus in the left kidney was visible on the radiograph of the abdomen.Cystoscopic examination showed that there was no urine flow from the right ureter. On retrograde pyelography a nearby normal ureter and pelvis were visible on both sides, but the left pelvis contained a stone.After treatment with intravenous blood and bicarbonate infusions, penicillin, and peritoneal dialysis, the patient showed only temporary improvement. On 16Received for publication 10 July 1964. March 1963 an ischaemic necrosis of the feet developed. The patient died in a uraemic coma.The condition was tentatively diagnosed as uraemia of unknown origin with a pelvic stone in the left kidney and multiple arteriosclerotic occlusions of the arteries of the right kidney and the legs. Moreover there were signs of an old myocardial infarct.
PATHOLOGICAL HNDINGS IN CASENecropsy revealed a regularly built, well-nourished man with oedema of the legs and scrotum. There was a bluish discoloration of the dorsal part...
