Abstract
BackgroundCalcium oxalate nephropathy is rare in current practice. It was a common complication during jejunoileal bypass, but much less seen in modern gastric bypass surgery for morbid obesity. The major cause of it is enteric hyperoxaluria.Case presentationWe report on a patient here with acute kidney disease due to calcium oxalate nephropathy, rather than the conditions mentioned above. The male patient received a Roux-en Y hepaticojejunostomy and common bile duct drainage. In addition to enteric hyperoxaluria, chronic kidney disease related metabolic acidosis, chronic diarrhea related volume depletion, a high oxalate and low potassium diet, long term ascorbic acid intake and long term exposure to antibiotics, all predisposed him to having oxalate nephropathy.ConclusionThis is the first case with such conditions and we recommend that similarly diagnosed patients avoid all these predisposing factors, in order to avoid this rare disease and its undesired outcome.
Highlights
Calcium oxalate nephropathy is rare in current practice
We report the first case of oxalate nephropathy related acute kidney injury receiving a Roux-en Y hepaticojejunostomy due to gall bladder carcinoma, not previously reported in the literature
Calcium oxalate crystal related renal injury in the past was mostly due to jejunoileal bypass (JIB), which was a surgical weight-loss procedure performed for the relief of morbid obesity during the 1950s through the 1970s
Summary
Oxalate nephropathy is a rare disease, and most cases are due to enteric hyperoxalauria. Calcium oxalate crystal related renal injury in the past was mostly due to a jejunoileal bypass (JIB) performed for the treatment of obesity. We report the first case of oxalate nephropathy related acute kidney injury receiving a Roux-en Y hepaticojejunostomy due to gall bladder carcinoma, not previously reported in the literature. He experienced frequent cholangitis and his bile cultures yielded Klebsiella pneumoniae, Citrobacter freundiim, Enterococcus sp., Group D streptococcus not enterococcus, and Escherichia coli Due to these conditions, he received Cefoperazone for an extensive period of time (6 months). The renal function was stable even the above conditions This time (three years after RYGB), he was admitted to hospital due to kidney injury (4.7 to 14.7 mg/dl of serum creatinine), which is less likely pre-renal azotemia. The patient himself had approved the course of treatment, and had given signed consent
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