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Primary hyperoxaluria type 1: strategy for organ transplantation.
[primary hyperoxaluria type 1]
Primary
hyperoxaluria
type
1
,
the
most
common
form
of
primary
hyperoxaluria
,
is
an
autosomal
recessive
disorder
caused
by
a
deficiency
of
the
liver
-
specific
enzyme
alanine
:
glyoxylate
aminotransferase
.
This
results
in
increased
synthesis
and
subsequent
urinary
excretion
of
the
metabolic
end-product
oxalate
and
the
deposition
of
insoluble
calcium
oxalate
in
the
kidney
and
urinary
tract
.
As
glomerular
filtration
rate
decreases
due
to
progressive
renal
involvement
,
oxalate
accumulates
and
results
in
systemic
oxalosis
.
Diagnosis
is
still
often
delayed
.
It
is
mainly
established
on
the
basis
of
clinical
and
sonographic
findings
,
urinary
oxalate
±
glycolate
assessment
,
and
DNA
analysis
.
Following
specific
conservative
measures
,
the
ultimate
management
is
based
on
organ
transplantation
.
Correction
of
the
enzyme
defect
by
liver
transplantation
should
be
planned
before
systemic
oxalosis
develops
to
optimize
outcomes
and
may
be
either
simultaneous
(
immunological
benefit
)
or
sequential
(
biochemical
benefit
)
liver
-kidney
transplantation
depending
on
disease
staging
,
facilities
,
and
access
to
deceased
or
living
donors
.
Allograft
and
patient
survival
currently
approaches
that
of
transplant
patients
with
kidney
transplantation
alone
and
with
other
diseases
requiring
combined
liver
-kidney
transplantation
.
In
addition
,
this
strategy
has
also
provided
significant
improvement
in
both
quality
of
life
and
statural
growth
.
Diseases
Validation
Diseases presenting
"the deposition of insoluble calcium oxalate in the kidney and urinary tract"
symptom
primary hyperoxaluria type 1
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