Vitamin C-Induced Oxalate Nephropathy

Abstract

Although a multitude of syndromes have been thoroughly described as a result of vitamin deficiencies, over consumption of such substances may also be quite dangerous. Intratubular crystallization of calcium oxalate as a result of hyperoxaluria can cause acute renal failure. This type of renal failure is known as oxalate nephropathy. Hyperoxaluria occurs as a result of inherited enzymatic deficiencies known as primary hyperoxaluria or from exogenous sources known as secondary hyperoxaluria. Extensive literature has reported and explained the mechanism of increased absorption of oxalate in malabsorptive syndromes leading to renal injury. However, other causes of secondary hyperoxaluria may also take place either via direct dietary consumption of oxalate rich products or via other substances which may metabolize into oxalate within the body. Vitamin C is metabolized to oxalate. Oral or parenteral administration of this vitamin has been used in multiple settings such as an alternative treatment of malignancy or as an immune booster. This article presents a clinical case in which ingestion of high amounts of vitamin C lead to oxalate nephropathy. This article further reviews other previously published cases in order to illustrate and highlight the potential renal harm this vitamin poses if consumed in excessive amounts.

Vitamin C-induced oxalate nephropathy: a case report

“…There are three recognized types of primary hyperoxaluria (PH): type 1 is due to defects in the gene that encodes the hepatic peroxisomal enzyme alanine glyoxylate aminotransferase (AGT); type 2 is due to defects in the gene that encodes the cytosolic enzyme glyoxylate reductase/hydroxypyruvate reductase (GRHPR); and type 3 is due to mutations in the uncharacterized gene DHDPSL. Secondary hyperoxaluria results from increased absorption in patients with intestinal malabsorption syndromes, direct dietary consumption of oxalate rich products, or ingestion of other substances (e.g., vitamin C), which may be metabolized into oxalate (7). …”

Favorable outcomes of prepackaged low‐residue diet on bowel preparation for colonoscopy: Endoscopist‐blinded randomized controlled trial

“…Failure of kidney function caused by the use of a sodium phosphate agent as colonoscopy preparation is well known . Even for the modest low‐volume method such as 2 L PEGA, there are unsolved concerns, which might be caused by excessive volume reduction by the preparation agent . Even though the present study had a relatively small sample size to fully estimate the risk of potential kidney injury, adverse outcome related to kidney was not encountered in any of the patients until the study completion date.…”

“…28 Even for the modest low-volume method such as 2 L PEGA, there are unsolved concerns, which might be caused by excessive volume reduction by the preparation agent. 8,27,29,30 Even though the present study had a relatively small sample size to fully estimate the risk of potential kidney injury, adverse outcome related to kidney was not encountered in any of the patients until the study completion date. Moreover, recent some studies demonstrated that the addition of adjuncts such as bisacodyl also has an additional benefit to achieve adequacy of bowel preparation.…”

Demographic Diversity of Food Intake and Prevalence of Kidney Stone Diseases in Indian Continent

“…Vitamin C, when administered in higher quantities into the human body, is reported to have caused kidney stones in some cases [32]. It is inferred that Vitamin C gets converted to oxalates [33]. But some study reported that the oxalate excretion is little related to the dietary intake [34].…”