oxalates and Diabetes-Mellitus--Type-1

A kidney transplant recipient with a medical history of type 1 diabetes mellitus (T1DM) presents to the clinic with an acute kidney injury (AKI) and diarrhoea. Kidney biopsy found deposition of focal oxalate crystals, and further investigation revealed a raised 24-hour urinary oxalate and reduced faecal elastase. Therefore, we present a case of acute oxalate nephropathy (AON) secondary to enteric hyperoxaluria as a result of pancreatic insufficiency caused by T1DM. T1DM is a common cause of end-stage renal failure and exocrine pancreatic insufficiency. Therefore, AON secondary to enteric hyperoxaluria should be considered in patients with a transplant AKI. Earlier testing of 24-hour urinary oxalate and faecal elastase could generate diagnosis before biopsy results and allow commencement of pancreatic replacement therapy earlier to avoid permanent loss of kidney function.

Topics: Acute Kidney Injury; Diabetes Mellitus, Type 1; Exocrine Pancreatic Insufficiency; Humans; Hyperoxaluria; Kidney; Oxalates; Pancreatic Elastase

Oxalosis is a metabolic disorder characterized by deposition of oxalate crystals in various organs including the kidney. Whereas primary forms result from genetic defects in oxalate metabolism, secondary forms of oxalosis can result from excessive intestinal oxalate absorption or increased endogenous production, e.g. after intoxication with ethylene glycol.. Here, we describe a case of acute crystal-induced renal failure associated with excessive ingestion of rhubarb in a type 1 diabetic with previously normal excretory renal function. Renal biopsy revealed mild mesangial sclerosis, but prominent tubular deposition of oxalate crystals in the kidney. Oxalate serum levels were increased.. Acute secondary oxalate nephropathy due to excessive dietary intake of oxalate may lead to acute renal failure in patients with preexisting renal disease like mild diabetic nephropathy. Attention should be payed to special food behaviors when reasons for acute renal failure are explored.

Topics: Acute Kidney Injury; Diabetes Mellitus, Type 1; Female; Humans; Middle Aged; Oxalates; Rheum

Topics: Adult; Citrates; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Female; Humans; Male; Middle Aged; Oxalates

Among 42 diabetics, there were 32 with the disease remaining uncontrolled after treatment. Their fasting blood glucose was 15.24 +/- 5.37 mmol/L (mean +/- S), urinary glucose 42.6 +/- 47.83 g/24 hr, urinary oxalate 0.43 +/- 0.16 mmol/24 hr and urinary citrate 3.60 +/- 2.28 mmol/24 hr All of these levels were higher than those in a control group (P less than 0.001). Urinary citrate level was significantly positively correlated with fasting blood glucose level (gamma = 0.3954, P less than 0.001). In the remaining 10 diabetics with the disease controlled after treatment the fasting blood glucose was 7.04 +/- 0.92 mmol/L, urinary citrate 1.92 +/- 0.96 mmol/24 hr and urinary oxalate 0.37 +/- 0.11 mmol/24 hr. All of these levels were significantly lower than those before treatment (P less than 0.01) and were not different from those in the control group (P greater than 0.05). This explains that urinary citrate and oxalate increased when diabetes is uncontrolled as a result of accelerated decomposition due to increased metabolism. Urinary oxalate level is correlated positively with that of urinary citrate (gamma = 0.3773, P less than 0.05). Urinary oxalate and citrate are good index reflecting diabetic metabolic changes. Analysis of urinary oxalate with ion-chromatography is accurate and rapid method worthy to be used clinically.

Topics: Adult; Chromatography, Ion Exchange; Citrates; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Female; Humans; Male; Middle Aged; Oxalates

The changes in blood serum concentrations of calcium, magnesium, inorganic phosphate, total activity of alkaline phosphatase and the activity of its bone fraction, as well as urinary excretion of calcium, phosphate, hydroxyproline and oxalate have been measured in 31 patients with insulin-dependent (type I) diabetes, in 31 patients with non-insulin-dependent (type II) diabetes and in 29 healthy subjects in the condition of low-calcium diet. The elevated urinary excretion of calcium, phosphate, hydroxyproline and oxalate, lowered blood serum level of magnesium, and increased total and bone fraction activities of alkaline phosphatase were found in diabetic patients. The urinary excretion of calcium and hydroxyproline, and the activity of bone fraction alkaline phosphatase were significantly higher in patients with type II diabetes than in those with type I diabetes. It was concluded that there is a significant relation between the state of metabolic normalization of diabetes and the degree of biochemical aberrations concerning calcium-phosphate metabolism.

Topics: Adult; Calcium; Circadian Rhythm; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Female; Humans; Hydroxyproline; Magnesium; Male; Middle Aged; Oxalates; Oxalic Acid; Phosphates

Topics: Cell Nucleus; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Humans; In Vitro Techniques; Lymphocytes; Oxalates