Acute oxalate nephropathy due to high vitamin C doses and exocrine pancreatic insufficiency

Abstract

Oxalate kidney injury can manifest as oxalate nephropathy or nephrolithiasis and present as acute kidney injury or even as end-stage renal disease. There are several known causes for acute oxalate nephropathy; however, the combination of exocrine pancreatic insufficiency with overconsumption of vitamin C has not been described before. In this case, a man in his early 80s presented with anorexia and extreme fatigue for 1 week. He had a history of myalgic encephalomyelitis, also known as chronic fatigue syndrome, for which he took several supplements, including high doses of vitamin C. Furthermore, several years ago, he was diagnosed elsewhere with exocrine pancreatic insufficiency. On admission, acute kidney injury was diagnosed. The kidney biopsy showed oxalate nephropathy as the cause. We diagnosed acute oxalate nephropathy due to high vitamin C doses and exocrine pancreatic insufficiency. Within 14 days, his kidney function got worse and he required renal replacement therapy.

Intravenous high-dose vitamin C for the treatment of severe COVID-19: study protocol for a multicentre randomised controlled trial

“…40 It was reported that high-dose VC was related to haemolysis in glucose-6-phosphate dehydrogenase (G-6-PD) deficiency, acute kidney injury (AKI) and acute oxalate nephropathy. [41][42][43][44] However, adverse effects were mostly reported in a few cases and were related to too large of doses, [41][42][43][44] non-standard administration 43 or high-risk underlying diseases. 44 Clinical trials with large sample sizes conducted on ICU patients 15 36-38 reported few adverse events (AEs).…”

“… 41–44 However, adverse effects were mostly reported in a few cases and were related to too large of doses, 41–44 non-standard administration 43 or high-risk underlying diseases. 44 Clinical trials with large sample sizes conducted on ICU patients 15 36–38 reported few adverse events (AEs). In addition, a survey 45 also indicated that other than the known complications of kidney damage and G-6-PD deficiency, HIVC appeared to be remarkably safe.…”

Acute oxalate nephropathy: A potential cause of acute kidney injury in diabetes mellitus—A case series from a single center

“…Urinary oxalate is derived either exogenously from dietary oxalate intake and net intestinal absorption or endogenously from oxalate synthesis mainly in the liver ( 10 ). Most reported AON cases in the literature have attributed the cause to either high intakes of oxalate-containing foods or oxalate precursors ( 12 – 15 ) or malabsorption induced by short-bowel syndrome ( 16 ), including celiac disease ( 17 ), gastric surgery (Roux-en-Y gastric bypass) ( 18 ), inflammatory bowel disease ( 19 ), chronic pancreatitis or pancreatic insufficiency, etc. ( 20 , 21 ).…”

Effect of high-dose intravenous vitamin C on prognosis in patients with SARS-CoV-2 pneumonia

“… 19 High dose VC has been reported to lead to hemolysis, acute renal injury, and acute oxalate nephropathy in patients with glucose 6 phosphate dehydrogenase (G6PD) deficiency. 20 , 21 However, these side effects have been reported in a few cases only, and have been associated with very high doses, or use of non-standard administration practices in high risk patients with underlying disorders. In this study, no adverse reactions have been observed in association with IVC administration.…”