oxalates and Granuloma

Primary hyperoxaluria (PH) is a rare genetic disorder characterized by overproduction of oxalate due to specific enzyme deficiencies in glyoxylate metabolism. The primary clinical presentation is in the form of recurrent urolithiasis, progressive nephrocalcinosis, end-stage renal disease, and systemic oxalosis. Herein, we present a case of PH who was diagnosed at 47 years of age after 6 years on hemodialysis. He presented with fatigue, anorexia, weight loss, and was found to have cachexia, diffuse edema, hepatomegaly, ascites, hypercalcemia, hyperphosphatemia, hypoalbuminemia, low parathyroid hormone levels, lytic and resorptive areas in the vertebrae, diffusely increased echogenity of the liver, multiple renal stones, and bilateral nephrocalcinosis. Bone marrow biopsy showed calcium oxalate crystals and crystal granulomas. The liver biopsy could not be performed. The absence of an identifiable reason for secondary forms, the severity of the clinical presentation, and pathological findings led to the diagnosis of PH2. He died while waiting for a potential liver and kidney donor. The presented case is consistent with the literature as he had renal stone disease in the third decade and end-stage renal disease in the fifth decade. Hypercalcemia was thought to be due to osteoclast-stimulating activity of macrophages constituting the granuloma. Erythropoietin-resistant anemia and hypothyroidism were thought to be due to accumulation of oxalate in the bone marrow and thyroid gland, respectively. It is very important to keep in mind the possibility of PH when faced with a patient with nephrocalcinosis and oxalate stone disease.

Topics: Ascites; Bone Marrow; Granuloma; Hepatomegaly; Humans; Hypercalcemia; Hyperoxaluria, Primary; Hypothyroidism; Kidney Failure, Chronic; Male; Middle Aged; Nephrocalcinosis; Oxalates; Renal Dialysis; Urolithiasis

We report a patient undergoing haemodialysis, who developed multiple subcutaneous nodules. Histology showed that the nodules were composed of deposits of crystals in the dermis, with an associated foreign-body reaction. The crystalline deposits were identified as calcium oxalate by histochemical staining, polarizing microscopy, and analytical electron microscopy.

Topics: Adult; Crystallization; Granuloma; Humans; Male; Oxalates; Renal Dialysis; Skin; Skin Diseases

Topics: Biopsy; Granuloma; Humans; Kidney Failure, Chronic; Male; Middle Aged; Oxalates; Renal Dialysis; Skin Diseases

The nature, prevalence, and specificity of birefringent calcific particles in granulomas of sarcoidosis have been examined, including histochemical reactions, single particle, and microchemical analyses. Particular attention was paid to small ovoid forms of which most were calcium oxalate monohydrate. Larger crystals, those within giant cells, and the birefringent component of a Schaumann complex were also calcium oxalate. Small ovoids appeared to originate in macrophages and to be precursors of other forms; they were found in 86% of lymph nodes and 73% of surgical lung specimens. They were not specific for sarcoidosis. Organisms could not be certainly identified in them. Their origin is discussed in relation to activated macrophages, calcium, and oxalate metabolism, and the role of calcium oxalate in granulomas is considered. Four particles from two cases were dolomite and two were a calcium-sulphur compound. The biologic origin of dolomite is reviewed.

Topics: Birefringence; Calcium Carbonate; Calcium Oxalate; Crystallization; Granuloma; Humans; Magnesium; Mycobacterium; Oxalates; Oxalic Acid; Sarcoidosis

Topics: Adult; Autopsy; Calcium; Cell Nucleus; Cytoplasm; Female; Granuloma; Hepatic Artery; Histiocytes; Histocytochemistry; Humans; Lymph Nodes; Lysosomes; Male; Microscopy, Electron; Middle Aged; Mitochondria; Oxalates; Peritoneal Cavity; Portal Vein; Sarcoidosis; Staining and Labeling

Topics: Cholesterol; Diagnosis; Ear Neoplasms; Granuloma; Humans; Osteomyelitis; Otitis Media; Oxalates; Pathology; Rabbits; Research; Surgical Procedures, Operative; Toxicology