Enteric hyperoxaluria due to malabsorption in patients with CF especially with ileal resection, in addition to loss
of gut Oxalobacter Formigenes due to prolonged antimicrobials, increases the risk of AON. Increased awareness of this condition and screening prior to lung transplant is recommended. We present a case of an irreversible oxalate nephropathy following complicated sequential double lung transplant successfully managed with dialysis and subsequently a living related kidney transplant. A 29-year-old man with cystic fibrosis underwent a sequential bilateral lung transplant for end-stage lung disease. There was a history Barasertib clinical trial of recurrent pulmonary infections and pneumothorax requiring regular hospitalizations and he was colonized with Pseudomonas aeruginosa. At 3 days of age he underwent an ileal resection for meconium ileus and was diagnosed with pancreatic exocrine insufficiency, for which he used enzyme supplements (Creon®, Abbott products, Pymble, NSW, Australia). He had normal renal function, normal endocrine pancreatic function and no prior history of renal calculi. A renal ultrasound, prior to lung transplant, demonstrated normal
size of right click here and left kidneys of 10.9 cm and 11.7 cm respectively. A renal isotope perfusion scan demonstrated bilateral homogenous uptake of the tracer with a GFR (glomerular filtration rate) of 117 mL/min. Following the lung transplant, his postoperative course was complicated by an anastomotic stricture and severe haemorrhage necessitating a repeat thoracotomy. He required multiple blood transfusions and became coagulopathic and hypotensive requiring intensive inotropic support. At the time of his lung transplant, either immunosuppression consisted of Basiliximab and methylprednisolone induction with maintenance tacrolimus and mycophenolate. He received antiviral, bacterial and fungal treatment and prophylaxis with moxifloxacin, co-trimoxazole, voriconazole, amikacin, tazocin, vancomycin and ganciclovir.
He developed acute renal failure and was started on continuous veno-venous haemodiafiltration on the second postoperative day and then intermittent haemodialysis after discharge from the intensive care unit (ICU) on day 10. During the postoperative period he received nasogastric feeds with omission of his pancreatic supplements. He resumed normal diet and Creon® supplements after day 10, but required insulin for new onset diabetes after transplantation. His renal failure was managed expectantly. Routine protocol lung biopsies showed no evidence of rejection. Six weeks post-transplant, he remained dialysis-dependent and oliguric (urine output <400 mL/day) but was haemodynamically stable. A renal ultrasound showed structurally normal kidneys without obstruction.