PDF(Pubmed)
Abstract：
Oxalate nephropathy, due to secondary hyperoxaluria has widely been described in gastrointestinal diseases. However, reports of oxalate nephropathy in newly diagnosed celiac disease are rare. A 72-year-old Caucasian male presented to the hospital with abdominal discomfort and acute renal insufficiency with a creatinine of 290 µmol/L. The clinical course, laboratory results and urinalysis were suspect for tubular injury. Renal biopsy showed calcium oxalate depositions. Elevated plasma and urine oxalate levels established the diagnosis oxalate nephropathy. The abdominal complaints with steatorrhea and positive anti-tissue transglutaminase antibodies were diagnosed as celiac disease, which was confirmed after duodenal biopsies. Treatment with prednisone, and gluten-free, low oxalate and normal calcium diet, lowered the plasma oxalate levels and improved his renal function. Decreased absorption of free fatty acids can lead to increased free oxalate in the colon due to the binding of free fatty acids to calcium, preventing the formation of the less absorbable calcium oxalate in the colon. Oxalate dispositions in the kidney can lead to acute tubular injury and chronic renal insufficiency. Celiac disease is therefore one of the intestinal diseases that can lead to hyperoxaluria and oxalate nephropathy.
摘要：
草酸盐肾病，由于继发性高草酸尿症已在胃肠道疾病中被广泛描述。然而,在新诊断的乳糜泻中很少有草酸肾病的报道。一名72岁的白人男性因腹部不适和急性肾功能不全而住院，肌酐为290µmol/L。临床过程，实验室结果和尿液分析怀疑是肾小管损伤。肾活检显示草酸钙沉积。血浆和尿草酸盐水平升高可诊断为草酸盐肾病。腹部不适为脂肪泻和抗组织转谷氨酰胺酶抗体阳性被诊断为乳糜泻，经十二指肠活检证实。用泼尼松治疗，和无麸质，低草酸盐和正常钙饮食，降低了血浆草酸盐水平，改善了他的肾功能。由于游离脂肪酸与钙的结合，游离脂肪酸的吸收减少会导致结肠中游离草酸盐的增加，防止结肠中可吸收的草酸钙的形成。肾脏中的草酸盐处置可导致急性肾小管损伤和慢性肾功能不全。因此，乳糜泻是可导致高草酸尿症和草酸盐肾病的肠道疾病之一。
