Update on Oxalate Crystal Disease

Abstract

Oxalate arthropathy is a rare cause of arthritis characterized by deposition of calcium oxalate crystals within synovial fluid. This condition typically occurs in patients with underlying primary or secondary hyperoxaluria. Primary hyperoxaluria constitutes a group of genetic disorders resulting in endogenous overproduction of oxalate, whereas secondary hyperoxaluria results from gastrointestinal disorders associated with fat malabsorption and increased absorption of dietary oxalate. In both conditions oxalate crystals can deposit in the kidney leading to renal failure. Since oxalate is primarily renally eliminated, it accumulates throughout the body in renal failure, a state termed oxalosis. Affected organs can include bones, joints, heart, eyes and skin. Since patients can present with renal failure and oxalosis before the underlying diagnosis of hyperoxaluria has been made, it is important to consider hyperoxaluria in patients who present with unexplained soft tissue crystal deposition. The best treatment of oxalosis is prevention. If patients present with advanced disease, treatment of oxalate arthritis consists of symptom management and control of the underlying disease process.

Gouty Tophus: Cytological Findings in a Case Diagnosed by Fine Needle Aspiration

“…The presence of uric acid crystals surrounded by macrophagic-histiocytic cells Considering the later, we contemplated a differential diagnosis with entities which have similar characteristics, such as epidermic cysts (keratin material), foreign-body inflammatory reactions, or hyperoxalosis (calcium oxalate crystals) [8] [9] [10]. Our first diagnosis was confirmed after the histological procedures and the high-level hyperuricemia (12 mg/100 mL) in his laboratory tests.…”

Primary Hyperoxaluria: A Case Report and Review of the Literature

“…Once the calcium oxalate crystals adhere to the cell, they are internalized, make changes in gene expression, cause cytoskeletal reorganization, and possibly fibroblast proliferation (1,15). Inflammasome is considered of major importance in the loss of kidney function, emphasizing the importance of anti-inflammatory therapies to slow the progression of nephropathy in inherited and acquired forms (17).…”

“…In some cases, however, the disease may persist unrecognized until adulthood (1). In systemic disease, calcium oxalate crystal deposits within different tissues, including bones, joints, heart, eyes, vessel walls, skin, and the central nervous system (1,15).…”

A patient with Primary Hyperoxaluria who developed excessive pericardial effusion despite intensive dialysis

“…Along with progressive decline of glomerular filtration rate (GFR< 30 ml/min/1.73 m 2 ) oxalate deposition occurs in many tissues and organs, such as heart (cardiomyopathy, conduction defects), nerveous system (dysesthesia, mononeuritis multiplex, optic atropy), muscles (myopathy) joints (arthropathy), skin (subcutaneous calcinotic nodules, masses, ulcerating), bone and bone marrow (pain, erythropoetin-resistant anemia and spontaneous fracture), blood vessels (vasospasm, livedo reticularis, vascular calcification), thyroid (hypothyroidism) and retina (crystaline macolopathy), leading to systemic involvement named oxalosis. Oxalosis is responsible for poor quality of life and severe complications [6][7][8][9][10]. Current information is limited to case reports and small case series, which are restricted to cardiomyopathy, valvular disease and conduction abnormalities [9,11].…”