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A 31-year-old woman with bilateral nephrectomy due to bleeding angiomyolipomas from tuberous sclerosis received a kidney transplant with good early graft function. Irreversible, oliguric renal allograft failure soon developed from widespread deposition of calcium oxalate crystals, involving 30% of tubules (Panels A and B, hematoxylin and eosin). The patient had abundant oxalate deposits in the skin (resembling tophaceous gout but without hyperuricemia) (Panels C and D); polarizing microscopy confirmed the presence of oxalate in a specimen from these deposits (Panel E). She had a plasma oxalate level of 62 µmol per liter (normal value, <2) and a history of self-medication . . . [Full Text of this Article] |
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