Acute oxalate nephropathy associated withClostridiumdifficileinfection

Abstract

Acute oxalate nephropathy has been associated with chronic diarrheal illness and only one case has been reported due to acute diarrhea secondary to Clostridium difficile colitis. To the best of our knowledge, this is the second case report of acute oxalate nephropathy due to C.difficile colitis. A 75-year-old man with a medical history of hypertension, type 2 diabetes mellitus, chronic kidney disease stage IV, recent C.difficile colitis was admitted for acute kidney injury with a creatinine (Cr) of 8.54 mg/dL (baseline Cr, 2.3–2.6 mg/dL). His urinalysis did not show any eosinophils, casts or crystals. Antinuclear antibody, antineutrophil cytoplasmic antibody, complement levels (C3 and C4) and hepatitis screen were negative; a renal ultrasound visualized no hydronephrosis. A kidney biopsy showed widespread tubular oxalate crystal deposition suggestive of hyperoxaluria as the cause of acute kidney injury. In conclusion, an acute diarrheal illness like C.difficile colitis can cause acute oxalate nephropathy.

Oxalate Nephropathy and the Mechanism of Oxalate-Induced Kidney Injury

“…The pH of urine also affects supersaturation. It has been suggested that metabolic acidosis provides favorable conditions for oxalate accumulation and precipitation in renal tissue [ 4 ]. Humans normally excrete millions of urinary crystals daily.…”

“…Oxalate nephropathy is defined as kidney injury induced by calcium oxalate (CaOx) crystal deposition in kidney tissues resulting in impaired renal function, which may present as acute kidney injury (AKI), chronic kidney disease (CKD), or even end-stage renal disease (ESRD) [1,2]. Oxalate nephropathy in most cases results from hyperoxaluria, which may be classified into primary and secondary or enteric hyperoxaluria [3][4][5]. The exact prevalence of oxalate nephropathy is unknown; however, the prognosis of oxalate nephropathy is poor.…”