Skip to main content

Main menu

  • Home
  • Content
    • Published Ahead of Print
    • Current Issue
    • Sections by Topic
    • Archives
    • Saved Searches
  • Authors
    • Submit a Manuscript
    • Trainee of the Year
    • Author Resources
    • Reprint Information
  • Editorial Team
  • Subscriptions
  • More
    • Advertising
    • Reprint Information
    • Impact Factor
    • About CJASN
    • Feedback
    • CJASN Relaunch
  • Other
    • JASN
    • Kidney News Online
    • In the Loop
    • American Society of Nephrology

User menu

  • Register
  • Subscribe
  • My alerts
  • Log in
  • My Cart

Search

  • Advanced search
American Society of Nephrology
  • Other
    • JASN
    • Kidney News Online
    • In the Loop
    • American Society of Nephrology
  • Register
  • Subscribe
  • My alerts
  • Log in
  • My Cart
American Society of Nephrology

Advanced Search

  • Home
  • Content
    • Published Ahead of Print
    • Current Issue
    • Sections by Topic
    • Archives
    • Saved Searches
  • Authors
    • Submit a Manuscript
    • Trainee of the Year
    • Author Resources
    • Reprint Information
  • Editorial Team
  • Subscriptions
  • More
    • Advertising
    • Reprint Information
    • Impact Factor
    • About CJASN
    • Feedback
    • CJASN Relaunch
  • Visit ASN on Facebook
  • Follow CJASN on Twitter
  • CJASN RSS
  • Community Forum

About the Cover

July 06, 2018; Volume 13,Issue 7

Cover image

Cover image expansion

On the Cover

What’s the diagnosis?

A 55 year-old man, originally from Cameroon, with a history of hypertension and Stage 3 CKD attributed to diabetes mellitus, presented with malaise and fatigue. He was diagnosed with AKI with BUN 127 mg/dL and serum creatinine (sCr) 18.9 mg/dL (baseline 1.5 mg/dL). Urinalysis revealed 1 WBC/hpf, no crystals, and urine protein/creatinine ratio 0.16 g/g. Serological testing was negative, and kidney ultrasound showed increased echogenicity. Kidney biopsy revealed numerous intraluminal calcium oxalate crystals consistent with oxalate nephropathy. On further questioning, the patient reported ingesting multiple unknown herbal bowel cleansing regimens while in Africa. He wasinitiated on hemodialysis with eventual kidney recovery by 8 weeks. No genetic testing was pursued. Follow-up sCr was 3.49 mg/dL (eGFR 22 ml/min per 1.73m2) off dialysis.

Light microscopy revealed 20 glomeruli, of which 5 were globally sclerotic. Patent glomeruli were normocellular without mesangial expansion. Moderate acute tubular injury was present. Numerous translucent crystals were present in tubule lumens and in epithelial cell cytoplasm that were birefringent under polarized light (H&E, Figure 1; silver, Figure 2). Diffuse interstitial edema was present in association with 20 – 25% tubulointerstitial fibrosis. IF and EM were unrevealing.

Primary hyperoxaluria results from autosomal recessive mutations in AGXT, GRHPR, or HOGA1. Secondary hyperoxaluria, as in this patient, has numerous etiologies and remains an uncommonly diagnosed cause of AKI. Etiologies of acquired oxalate nephropathy include increased dietary oxalate intake, ethylene glycol toxicity, fat malabsorption, vitamin C supplementation, and B6 deficiency. In contrast, calcium phosphate crystals are blue to purple on H&E, react with von Kossa stain, and are not birefringent.

(Images and text provided by Javier Rodriguez-Sanchez, MD; Mohamad Hanouneh, MD; and C. John Sperati, MD, MHS, Johns Hopkins University, Department of Medicine, Division of Nephrology, Baltimore, Maryland)

Back to top
PreviousNext

In this issue

Clinical Journal of the American Society of Nephrology: 13 (7)
Clinical Journal of the American Society of Nephrology
Vol. 13, Issue 7
July 06, 2018
  • Table of Contents
  • About the Cover
  • Index by author
Sign up for alerts
View Selected Citations (0)

Jump to

  • Patient Voice
  • Editorials
  • Original Articles
    • Acid/Base and Electrolyte Disorders
    • Chronic Kidney Disease
    • Geriatric and Palliative Nephrology
    • Glomerular and Tubulointerstitial Diseases
    • Maintenance Dialysis
    • Transplantation
  • Erratum
  • Kidney Case Conference: Attending Rounds
  • Nephropharmacology for the Clinician
  • Perspectives
  • Feature
  • Review
  • Most Read
  • Most Cited
Loading
  • Pharmacology behind Common Drug Nephrotoxicities
  • Clinical Pharmacology of Oral Anticoagulants in Patients with Kidney Disease
  • Clinical Pharmacology of Antihypertensive Therapy for the Treatment of Hypertension in Chronic Kidney Disease
  • Burden of Proof for Tolvaptan in ADPKD
  • Thrombotic Microangiopathy and the Kidney
More...

About

  • ASN
  • CJASN
  • ASN Journals
  • ASN Podcasts
  • CJASN Relaunch

Author Information

  • Submit a Manuscript
  • Trainee of the Year
  • Author Resources
  • Reuse/Reprint Policy

More information

  • Advertise
  • Subscribe
  • Email Alerts
  • Sections by Topic

© 2019 American Society of Nephrology

Print ISSN - 1555-9041 Online ISSN - 1555-905X

Powered by HighWire