A 64-Year-Old Woman with Diabetes Mellitus Associated with Increased Urinary Oxalate Excretion Presenting with Acute Kidney Injury Due to Acute Oxalate Nephropathy

BACKGROUND Acute oxalate nephropathy (AON) is a rare complication of diabetes mellitus (DM), resulting in kidney damage. This report describes the case of a 64-year-old woman with DM associated with increased urinary oxalate excretion presenting with acute kidney injury (AKI) due to AON. CASE REPORT A 64-year-old woman with recently diagnosed diabetes mellitus and hypertension presented to the hospital with right-sided flank pain. Initial renal function tests (RFTs) indicated a blood urea nitrogen (BUN) level of 68.6 mg/dL and a serum creatinine of 9.0 mg/dL, up from a serum creatinine of 1.5 mg/dL recorded a month earlier. Due to further deterioration of her metabolic panel and worsening anuria, hemodialysis was commenced. A biopsy was performed to establish the cause, which revealed diabetic nephrosclerosis and calcium oxalate crystals in the tubules. A detailed review of the patient’s medical history was conducted, yet no definitive factor emerged. We inferred that diabetes triggered acute oxalate nephropathy due to increased oxalate excretion, which subsequently progressed to end-stage renal disease. The patient’s renal function did not recover, leading to maintenance hemodialysis use for end-stage renal failure. CONCLUSIONS This observation underscores the necessity for assessing oxalate nephropathy in unexplained renal failure, as prompt detection and treatment could improve outcomes. This report highlights a rare but important complication of DM, and that patients who present with AKI should be investigated for the presence of AON.