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Diagnosis of primary hyperoxaluria type 1 by determination of peritoneal dialysate glycolic acid using standard organic-acids analysis method.
[primary hyperoxaluria type 1]
Hyperglycolic
hyperoxaluria
is
an
important
biochemical
diagnostic
hallmark
for
primary
hyperoxaluria
type
1
(
PH
1
)
.
Biochemical
work-up
on
urinary
specimens
becomes
impossible
after
the
development
end-
stage
renal
failure
and
anuria
.
We
studied
the
diagnostic
value
of
determining
glycolic
acid
content
in
peritoneal
dialysate
effluent
in
PH
1
.
We
performed
a
comparative
study
on
an
anuric
continuous
ambulatory
peritoneal
dialysis
(
CAPD
)
patient
whose
PH
1
was
confirmed
by
genetic
study
and
on
5
anuric
CAPD
controls
.
Specimens
were
taken
from
each
bag
of
peritoneal
dialysate
effluent
over
a
24
-
hour
period
,
and
the
corresponding
drainage
volume
was
noted
.
The
specimens
were
then
processed
using
standard
procedures
for
organic-acid
analysis
.
They
underwent
ethyl
acetate
extraction
,
followed
by
semiquantitative
analysis
of
organic
acids
by
gas
chromatography
mass
spectrometry
(
GCMS
)
.
The
daily
output
of
glycolic
acid
in
peritoneal
dialysate
for
each
individual
was
then
estimated
.
All
6
patients
were
receiving
four
2
-
L
CAPD
exchanges
daily
.
The
estimated
daily
glycolic
acid
output
for
the
PH
1
patient
was
48
.
3
micromol
daily
.
The
mean
glycolic
acid
output
for
the
5
controls
was
estimated
to
be
much
lower
at
19
.
6
micromol
daily
(
range
:
15
.
1
-
27
.
5
micromol
daily
)
.
Standard
organic-acid
analysis
for
glycolic
acid
in
peritoneal
dialysate
could
be
a
useful
initial
screening
tool
before
invasive
or
sophisticated
testing
is
done
in
CAPD
patients
with
suspected
PH
1
.
Diseases
Validation
Diseases presenting
"mean glycolic acid output"
symptom
primary hyperoxaluria type 1
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