Review
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World J Nephrol. Nov 6, 2014; 3(4): 122-142
Published online Nov 6, 2014. doi: 10.5527/wjn.v3.i4.122
Nephropathy in dietary hyperoxaluria: A potentially preventable acute or chronic kidney disease
Robert H Glew, Yijuan Sun, Bruce L Horowitz, Konstantin N Konstantinov, Marc Barry, Joanna R Fair, Larry Massie, Antonios H Tzamaloukas
Robert H Glew, Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
Yijuan Sun, Antonios H Tzamaloukas, Renal Section, Raymond G Murphy Veterans Affairs (VA) Medical Center and Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87108, United States
Bruce L Horowitz, Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
Konstantin N Konstantinov, Rheumatology Section, Raymond G Murphy VA Medical Center and Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87108, United States
Marc Barry, Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States
Joanna R Fair, Radiology Service, Raymond G Murphy VA Medical Center and Department of Radiology, University of New Mexico School of Medicine, Albuquerque, NM 87108, United States
Larry Massie, Pathology Section, Raymond G Murphy VA Medical Center and Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM 87108, United States
Author contributions: Glew RH contributed the section on biochemistry, endogenous production and excretion of oxalate, including the bibliographic search of these sections and made repeatedly extensive and critical revisions of the manuscript; Sun Y and Horowitz BL assisted in the conception of the work, including the bibliographic search and made critical revisions of the manuscript; Konstantinov KN was responsible for the section on pathophysiology including the bibliographic search; Barry M and Massie L are responsible for the section on Pathology; Fair JR is responsible for the section on imaging; Tzamaloukas AH conceived this work, wrote parts of the report, provided a substantial part of references and revised critically the report.
Correspondence to: Antonios H Tzamaloukas, MD, Renal Section, Raymond G Murphy VA Medical Center and Department of Medicine, University of New Mexico School of Medicine, 1501 San Pedro SE, Albuquerque, NM 87108, United States. antonios.tzamaloukas@va.gov
Telephone: +1-505-2651711 Fax: +1-505-2566443
Received: April 26, 2014
Revised: June 12, 2014
Accepted: August 27, 2014
Published online: November 6, 2014
Abstract

Hyperoxaluria can cause not only nephrolithiasis and nephrocalcinosis, but also renal parenchymal disease histologically characterized by deposition of calcium oxalate crystals throughout the renal parenchyma, profound tubular damage and interstitial inflammation and fibrosis. Hyperoxaluric nephropathy presents clinically as acute or chronic renal failure that may progress to end-stage renal disease (ESRD). This sequence of events, well recognized in the past in primary and enteric hyperoxalurias, has also been documented in a few cases of dietary hyperoxaluria. Estimates of oxalate intake in patients with chronic dietary hyperoxaluria who developed chronic kidney disease or ESRD were comparable to the reported average oxalate content of the diets of certain populations worldwide, thus raising the question whether dietary hyperoxaluria is a primary cause of ESRD in these regions. Studies addressing this question have the potential of improving population health and should be undertaken, alongside ongoing studies which are yielding fresh insights into the mechanisms of intestinal absorption and renal excretion of oxalate, and into the mechanisms of development of oxalate-induced renal parenchymal disease. Novel preventive and therapeutic strategies for treating all types of hyperoxaluria are expected to develop from these studies.

Keywords: Dietary hyperoxaluria, Chronic oxalate nephropathy, Acute oxalate nephropathy, Acute tubular necrosis, Interstitial nephritis, Nephrocalcinosis, Calcium oxalate nephrolithiasis, Oxalate transporters, Inflammasomes

Core tip: Chronic nephropathy secondary to dietary hyperoxaluria has been reported in a limited number of patients. Dietary oxalate intake in these patients was lower than the average intake in certain parts of the world. This raises the question whether dietary hyperoxaluria has been a neglected cause of chronic kidney disease. This question along with recent findings elucidating the pathogenesis of oxalate nephropathy calls for further research in epidemiology, prevention and treatment of hyperoxaluria.