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Hyperoxaluria and oxalosis

Hyperoxaluria is the presence of excess oxalate in the urine. This excess oxalate combines with calcium and forms kidney stones which can cause serious kidney problems. Oxalosis is the failure of the kidneys and occurs in people with primary and intestinal causes of hyperoxaluria and a buildup of oxalates in the blood. As a result, the oxalates get deposited in the blood vessels, bones and other organs causing different problems.

Symptoms

The first sign of hyperoxaluria is the presence of kidney stone which can produce the below symptoms:

  • Pain while urinating
  • Blood in urine
  • An urge to urine more often
  • Fever and chills
  • Flank pain (pain in the lower part of the ribs on the back)

When to consult the doctor?

Presence of symptoms associated with kidney stones especially in children indicates an underlying kidney problem. Therefore, such children should be taken for doctor’s consultation. Also, adults with the signs need to check with the doctor.

If a person is diagnosed with hyperoxaluria, then the family members are at risk of having kidney stones and should be evaluated.

Causes

Hyperoxaluria can be caused due to the following reasons:

  • Excess consumption of oxalic acid rich foods
  • Certain intestinal diseases such as Crohn’s disease may increase the absorption of oxalates
  • Presence of a rare genetic disorder in which the liver loses its ability to produce the enzyme that prevents excess production of oxalate
  • Changes in the kidney function to eliminate excess oxalates

Risk factors

Hyperoxaluria is relatively common in people with

  • kidney stones
  • a family history of the disease

Complications

If hyperoxaluria is left untreated it can result in kidney damage over a period. Eventually this can lead to kidney failure which causes problems such as:

  • Low or no urine output
  • Loss of appetite
  • Pale skin color associated with anemia
  • Feeling of illness and tiredness
  • Swelling of hands and feet

Oxalosis can result in multiple problems such as skin ulcers, bone diseases, eye problems, heart problems, and anemia if a proper treatment is not provided.

Diagnosis

When a patient complains of the symptoms of kidney stones, the doctor conducts physical examination, takes medical and medication history of the patient to draw clues of the condition. The below tests are needed to confirm the presence of hyperoxaluria:

  • Urine tests to check the levels of oxalates and other metabolic products
  • Blood tests to check the levels of oxalates and understand the kidney function
  • Stone analysis to know the composition of the kidney stones
  • Imaging studies such as x-rays, CT scan, and ultrasound to detect the presence of kidney stones

Further tests to confirm the diagnosis include:

  • Kidney and liver biopsy
  • Bone marrow biopsy
  • Eye examination and tests
  • Echocardiogram

Treatment

Treatment is based on the type and severity of hyperoxaluria. The doctor may opt for the below treatment options to control the synthesis of calcium oxalate crystals:

  • Vitamin B6 containing medications are effective in lowering the levels of oxalate in urine. Phosphates and calcium taken in the form of oral preparations prevent calcium oxalate crystal formation.
  • If the kidney function is normal then the doctor might suggest increasing the fluid intake to prevent the formation of crystals and kidney stones.
  • If the dietary intake of oxalate-rich foods is the cause, then the doctor may recommend a change in the diet plan. Additionally, salt and animal protein intake should be restricted if primary hyperoxaluria is present.
  • If kidney stones are causing pain, they need to be removed surgically or may be broken down to small fragments which can easily pass out of the body through the urine.
  • If the kidney function is lost then dialysis may be required. It is a temporary solution which does not control the oxalate production. Alternatively a liver or kidney transplant may be chosen to overcome the problem with dialysis.
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