A recent case study published in BMC Nephrology found the association of oxalate nephropathy with newly diagnosed celiac disease, a condition that affects the small intestine. While oxalate nephropathy is commonly reported in gastrointestinal diseases, such as primary hyperoxaluria, its occurrence in celiac disease is extremely rare.
A 72-year-old Caucasian male was admitted to the hospital with abdominal discomfort and acute renal insufficiency. Upon evaluation, the patient's creatinine levels were found to be significantly elevated at 290 µmol/L. A comprehensive assessment, including clinical course, laboratory results, and urinalysis, pointed towards tubular injury. To confirm the diagnosis, a renal biopsy was conducted, revealing the presence of calcium oxalate depositions. This led to the diagnosis of oxalate nephropathy.
Further investigation revealed that the patient had been experiencing abdominal complaints, steatorrhea (fatty stools), and tested positive for anti-tissue transglutaminase antibodies. Following duodenal biopsies, celiac disease was confirmed as the underlying cause for these symptoms.
To address the patient's condition, a multidimensional treatment approach was implemented. The patient was prescribed prednisone to manage the symptoms of celiac disease, and a strict gluten-free diet was initiated. Additionally, the patient was placed on a low oxalate and normal calcium diet. These dietary modifications aimed to decrease the absorption of free fatty acids, which can lead to increased free oxalate in the colon. The binding of free fatty acids to calcium prevents the formation of the less absorbable calcium oxalate in the colon, thereby reducing the risk of oxalate nephropathy.
Over the course of treatment, the patient's plasma oxalate levels gradually decreased, and his renal function improved. This response to therapy highlights the importance of prompt diagnosis and the implementation of appropriate management strategies in cases of oxalate nephropathy associated with celiac disease.
This rare case serves as a reminder of the intricate interplay between gastrointestinal diseases and renal health. Through continued research and enhanced clinical awareness, we can strive to improve the diagnosis, management, and overall outcomes for patients affected by oxalate nephropathy and associated conditions like celiac disease.
Zijlstra, H. W., & Stegeman, C. A. (2023). Oxalate nephropathy in an elderly patient with newly diagnosed celiac disease – a case report. In BMC Nephrology (Vol. 24, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12882-023-03241-y