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Primary hyperoxaluria type 1: An underestimated cause of nephrocalcinosis and chronic renal failure in Saudi Arabian children.
[primary hyperoxaluria type 1]
Primary
hyperoxaluria
type
I
(
PHI
)
is
a
rare
metabolic
disease
caused
by
deficiency
or
abnormalities
of
the
peroxisomal
enzyme
alanine-glyoxylate
aminotransferase
.
In
the
majority
of
patients
,
the
clinical
expression
of
PHI
is
characterized
by
recurrent
calcium
oxalate
urolithiasis
,
nephrocalcinosis
and
renal
failure
.
Sixteen
children
aged
5
months
to
14
years
were
diagnosed
as
PHI
over
a
10
-
year
period
ending
in
June
1997
.
The
diagnosis
was
established
by
quantitative
urinary
oxalate
excretion
,
or
by
a
high
urine
oxalate
/
creatinine
ratio
on
spot
urines
.
The
majority
of
patients
had
nephrolithiasis
(
13
/
16
)
and
/
or
nephrocalcinosis
(
12
/
16
)
.
Four
patients
already
had
advanced
chronic
renal
failure
at
the
time
of
diagnosis
.
Altogether
,
PHI
accounted
for
20
%
of
nephrocalcinosis
and
6
%
of
end-
stage
renal
disease
.
Two
patients
had
a
complete
response
to
pyridoxine
therapy
,
while
four
patients
had
a
partial
response
.
Eight
patients
underwent
organ
transplantation
,
three
underwent
kidney
transplantation
,
three
received
combined
liver
/
kidney
transplantation
for
end-
stage
renal
disease
,
and
two
received
isolated
preemptive
liver
transplantation
.
Combined
organ
transplantation
provided
the
best
long
-term
results
.
Diseases
Validation
Diseases presenting
"high urine oxalate/creatinine ratio on spot"
symptom
primary hyperoxaluria type 1
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