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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
"common form"
symptom
achondroplasia
alexander disease
benign recurrent intrahepatic cholestasis
cadasil
child syndrome
classical phenylketonuria
cutaneous mastocytosis
erythropoietic protoporphyria
familial mediterranean fever
hereditary cerebral hemorrhage with amyloidosis
hodgkin lymphoma, classical
holt-oram syndrome
homocystinuria without methylmalonic aciduria
oral submucous fibrosis
pendred syndrome
primary hyperoxaluria type 1
severe combined immunodeficiency
thoracic outlet syndrome
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