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J Nephropathol. 2016;5(2): 79-83.
doi: 10.15171/jnp.2016.14
PMID: 27152294
PMCID: PMC4844913
Scopus ID: 84963603741
  Abstract View: 2912
  PDF Download: 1311

Case Report

Acute oxalate nephropathy associated with orlistat

Youshay Humayun 1 * , Kenneth C. Ball 1, Jack R. Lewin 2, Anna A. Lerant 3,4, Tibor Fülöp 1

1 Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
2 Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi, USA
3 Department of Anesthesiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
4 Simulation and Interprofessional Education Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
*Corresponding author: Youshay Humayun, M.D, Department of Medicine, University of Mississippi Medical Center, Mississippi, USA. yhumayun@gmail.com

Abstract

Background: Obesity is a major world-wide epidemic which has led to a surge of various weight loss-inducing medical or surgical treatments. Orlistat is a gastrointestinal lipase inhibitor used as an adjunct treatment of obesity and type 2 diabetes mellitus to induce clinically significant weight loss via fat malabsorption.

Case Presentation:We describe a case of a 76-year-old female with past medical history of chronic kidney disease (baseline serum creatinine was 1.5-2.5 mg/dL), hypertension, gout and psoriatic arthritis, who was admitted for evaluation of elevated creatinine, peaking at 5.40 mg/dL. She was started on orlistat 120 mg three times a day six weeks earlier. Initial serologic work-up remained unremarkable. Percutaneous kidney biopsy revealed massive calcium oxalate crystal depositions with acute tubular necrosis and interstitial inflammation. Serum oxalate level returned elevated at 45 mm/l (normal <27). Timed 24-hour urine collection documented increased oxalate excretion repeatedly (54-96 mg/24 hour). After five renal dialysis sessions in eighth days she gradually regained her former baseline kidney function with creatinine around 2 mg/dL. Given coexisting proton-pump inhibitor therapy, only per os calcium-citrate provided effective intestinal oxalate chelation to control hyperoxaluria.

Conclusions: Our case underscores the potential of medically induced fat malabsorption to lead to an excessive oxalate absorption and acute kidney injury (AKI), especially in subjects with pre-existing renal impairment. Further, it emphasizes the importance of kidney biopsy to facilitate early diagnosis and treatment.

Keywords: Acute kidney injury, Dialysis, Oxalate, Oxalate nephropathy, Proton-pump inhibitor, Weight loss supplement

Implication for health policy/practice/research/medical education:

Acute oxalate nephropathy may be an under-recognized and important cause of renal failure in patients taking fat malabsorbtive weight loss supplements. Percutaneous kidney biopsy and timed 24-hour urine collections for oxalate excretion may expedite the diagnosis. The oxalate binding properties of per os calcium supplements are not sufficiently studied in advanced renal failure.

Please cite this paper as: Humayun Y, Ball KC, Lewin JR, Lerant AA, Fülöp T. Acute oxalate nephropathy associated with orlistat. J Nephropathol. 2016;5(2):79-83. DOI: 10.15171/jnp.2016.14

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ePublished: 29 Mar 2016
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