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[Primary hyperoxaluria].
[primary hyperoxaluria type 1]
Primary
hyperoxalurias
are
rare
recessive
inherited
inborn
errors
of
glyoxylate
metabolism
.
They
are
responsible
for
progressive
renal
involvement
,
which
further
lead
to
systemic
oxalate
deposition
,
which
can
even
occur
in
infants
.
Primary
hyperoxaluria
type
1
is
the
most
common
form
in
Europe
and
is
due
to
alanine-glyoxylate
aminostransferase
deficiency
,
a
hepatic
peroxisomal
pyridoxin-dependent
enzyme
.
Therefore
primary
hyperoxaluria
type
1
is
responsible
for
hyperoxaluria
leading
to
aggressive
stone
formation
and
nephrocalcinosis
.
As
glomerular
filtration
rate
decreases
,
systemic
oxalate
storage
occurs
throughout
all
the
body
,
and
mainly
in
the
skeleton
.
The
diagnosis
is
first
based
on
urine
oxalate
measurement
,
then
on
genotyping
,
which
may
also
allow
prenatal
diagnosis
to
be
proposed
.
Conservative
measures
-
Â
including
hydration
,
crystallization
inhibitors
and
pyridoxine
Â
-
are
safe
and
may
allow
long
lasting
renal
survival
,
provided
it
is
given
as
soon
as
the
diagnosis
has
been
even
suspected
.
No
dialysis
procedure
can
remove
enough
oxalate
to
compensate
oxalate
overproduction
from
the
sick
liver
,
therefore
a
combined
liver
and
kidney
transplantation
should
be
planned
before
advanced
renal
disease
has
occurred
,
in
order
to
limit
/
avoid
systemic
oxalate
deposition
.
In
the
future
,
primary
hyperoxaluria
type
1
may
benefit
from
hepatocyte
transplantation
,
chaperone
molecules
,
etc
.
Diseases
Validation
Diseases presenting
"a hepatic peroxisomal pyridoxin-dependent enzyme"
symptom
primary hyperoxaluria type 1
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