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Nephrol Dial Transplant (1993) 8: 1333-1337
© 1993 European Renal Association-European Dialysis and Transplant Association

research-article

Thresholds of serum calcium oxalate supersaturation in relation to renal function in patients with or without primary hyperoxaluria

M. Marangella, D. Cosseddu, M. Petrarulo, C. Vitale and F. Linari

Renal Stone Laboratory and Nephrology Division, Ospedale Mauriziano Umberto I Torino, Italy

Correspondence and offprint requests to: Correspondence and offprint requests to: Martino Marangella MD, Laboratorio Calcolosi Renale, Ospedale Mauriziano Umberto I, Largo Turati, 62, 10128 Torino, Italy.

Systemic oxalosis is a constant feature in patients with primary hyperoxaluria type 1 (PH1) and chronic renal failure (CRF) and is not prevented by regular dialysis (RDT), because removal cannot keep up with retention and overproduction of oxalate. These patients are candidates to kidney and/or liver transplantation, which should be ideally planned prior to the development of oxalosis. However, methods to detect the presence and extent of oxalosis are invasive and poorly reproducible, and only indirect approaches are feasible. Because supersaturation of body fluids is an essential condition for oxalotic deposits to form, we have assessed serum calcium oxalate saturation (ßCaox) in 12 patients with PH1 and 26 with PH1-unrelated renal diseases and varying degrees of CRF. Nineteen healthy individuals were taken as controls. ßCaox was closely dependent on oxalate serum levels. Serum oxalate and ßCaox were increased in patients with CRF as compared to controls, and were inversely related to GFR, assessed as creatinine clearance. However, at any level of GFR, both were always greater in PH1 patients. From the slopes of the regression of ßCaox over CICr, saturation was predicted to be obtained at CICr ranging 24–34 and 8–11 ml/min/1.73 m2 in PH1 and non-PH1 patients respectively. Based on the dependence of ßCaox on oxalate, saturation was associated with serum oxalate between 44 and 46 µmol/l, irrespective of either the prevailing GFR or the underlying disease. These simple procedures represent a valuable non-invasive tool to define the risk of systemic oxalosis and may assist in timing of transplantation.

Keywords: calcium oxalates; chronic renal failure; oxalate; oxalosis; primary hyperoxaluria


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