Oxalate deposition in tissues

N. Engin Aydin and Ufuk Usta

Inonu University Faculty of Medicine, Pathology Laboratory, Malatya, Turkey

Correspondence and offprint requests to: N. Engin Aydin, Inonu University Faculty of Medicine, Pathology Laboratory, Malatya, TR, Turkey. Email: eaydin{at}inonu.edu.tr

Keywords: granulomatous reaction; oxalate deposition; oxalosis; primary hyperoxaluria type I; renal osteodystrophy

An 11-year-old boy was found to have primary hyperoxaluria type I (urine oxalate 828 mg/l, N 140–420 mg/l). His mother had kidney stones and the parents were second degree relatives. After 18 months of dialysis, femoral neck fracture occurred, which was assumed to be related to renal osteodystrophy. During the surgical procedure to fix the fracture site internally, biopsies were taken which showed fibrosis and histiocytic reaction with multinucleated foreign body macrophages (Figure 1). Under polarized light microscopy birefringent oxalate crystals were detected (Figure 2).



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Fig. 1. Low power view showing fibrous tissue with multinucleated foreign body giant cells (haematoxylin and eosin, x100).

 


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Fig. 2. Under polarized light prominent crystalline material deposition can be seen leading to a diagnosis of oxalate deposition bone disease (haematoxylin and eosin, x100).

 
In oxalosis, oxalate deposits are mainly found in the heart and in smooth muscle cells of vessels and other organs [1,2]. Bone involvement in our patient presumably started in the rich vascular network of the bone marrow and finally, with a component of renal osteodystrophy, led to a pathological fracture. Severe oxalate bone disease appears to be the consequence of the granulomatous reaction induced by oxalate deposition.

Acknowledgments

This case was presented and appeared in abstract form at the 16th Symposium of Turkish Pathology Association, 15th October 2002, Turkey.

Conflict of interest statement. None declared.

References

  1. Toussaint C, Vienne A, De Pauw L et al. Combined liver–kidney transplantation in primary hyperoxaluria type 1. Bone histopathology and oxalate body content. Transplantation 1995; 59: 1700–1704[ISI][Medline]
  2. Gagnadoux MF, Lacaille F, Niaudet P et al. Long term results of liver–kidney transplantation in children with primary hyperoxaluria. Pediatr Nephrol 2001; 16: 946–950[CrossRef][ISI][Medline]




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