Causes and risk factors
Hyperoxluria is caused due to enzyme that prevents the built-up of oxalate. Depending upon the deficiency of the enzyme, it is divided into three types – Type I, Type II, and Type III. Type I is caused due to deficiency of liver enzyme namely alanine glyoxalate aminotransferase. While Type II is caused due to deficiency of glyoxylate reductase or hydroxypyruvate reductase. Type III is caused due to deficiency of some unknown enzyme. This enzyme deficiency is caused due to certain genetic factors. Mutation in gene AGXT and GRHPR leads to excess oxalate excretion in urine. Secondary hyperoxluria is caused due to certain diseases like Crohn’s diseases, chronic pancreatitis, and loss of calcium in intestine or biliary tract diseases, etc. High intake of foods rich in oxalate and animal protein rich diet can lead to high levels of oxalate in the body. It is known as dietary hyperoxluria. In some cases, excessive oxalate intake in diet or increased endogenous production can occur, the exact cause for this is not known. This type is called as idiopathic hyperoxluria. Certain triggering factors can provoke this condition. A few among them are excessive vitamin C intake, pyridoxine deficiency, etc.
Clinical presentation:
The complaints are seen gradually. Deposition occurs in different parts of the body like bones, joints, eyes, and heart; however, the bones are more commonly affected. It leads to decreased osteoblast activity. Formation of stone in kidney and bladder is seen. Hyperoxluria can lead to local as well as systemic complaints. Difficulty in swallowing, burning in different parts of the body like esophagus, pharynx, etc., are seen. In extreme affections it causes cardiac and renal failure. Convulsion can also occur. Hyperoxluria is often associated with urolithiasis.
Investigations:
Diagnosis is done on the basis of symptoms narrated by the patient and examination is difficult. Taking into consideration the complaints, certain investigations are advised. These consist of routine blood test, urine routine along with 24 hours urine sample is tested. Electrolyte levels, ultrasonography, liver biopsy, and CT scan or MRI can also be advised.
Treatment:
Treating the underlying cause is the main line of treatment. Diet containing calcium and oxalate needs to be limited. Medications like calcium supplements, magnesium supplements, or orthophosphate supplements are started. Low-fat diet and low vitamin C intake is recommended. Other medications for symptomatic relief are advised. In severe cases where the kidney is severely damaged, dialysis, or in rare cases, kidney transplantation is needed.
Other Modes of treatment:
Certain other modes of treatment can also be helpful in coping up with the symptoms. Taking into consideration the symptoms in a holistic way, homoeopathy can offer a good aid for the relief of the symptoms. The Ayurvedic system of medicine which uses herbs and synthetic derivates can also be beneficial in combating the complaints. Certain yoga exercises can also be helpful in strengthening the muscles.
Facts and figures:
The incidence of hyperoxluria is 1 in 3 million people.
Recent update:
Certain studies have shown that banana stem juice can possibly treat the condition.
