Dietary Supplementation in the Pursuit of Wellness Trends: A Case of Severe AKI Secondary to Oxalate Nephropathy

Introduction: Oxalate nephropathy is a rare cause of acute kidney injury (AKI) resulting from calcium oxalate crystal deposition in renal tubules. Primary drivers of acquired hyperoxaluria are dietary excess, fat malabsorption or enteric dysfunction. Increasing use of dietary supplements in wellness practices may inadvertently contribute to oxalate overload. Here, we present a case of oxalate nephropathy in an elderly male exacerbated by excessive walnut consumption (a high-oxalate food) and bile acid deficiency from cholecystostomy tube placement. Case Description: A 77-year-old Kurdish male with stage 3b chronic kidney disease, type 2 diabetes mellitus, hypertension and calcium oxalate kidney stones presented to emergency department with altered mental status and bilateral lower extremity edema. Notably, had a recent percutaneous cholecystostomy for acute cholecystitis with tube removal four days prior to admission. On presentation, laboratory values revealed severe AKI, serum creatinine 10 mg/dL (baseline 1.9mg/dl), BUN 75 mg/dL, serum bicarbonate 10 mmol/L, pH 7.04. A computed tomography scan of the abdomen revealed no obstruction or stones. Extensive serological workup was unremarkable. Despite supportive therapy, renal function declined necessitating hemodialysis. Kidney biopsy revealed extensive calcium oxalate crystal deposition confirming oxalate nephropathy with background of mild diabetic glomerulopathy. Further review revealed that his prior 24-hour urine study showed hypocitraturia and severe hyperoxaluria. Unfortunately, despite being prescribed potassium citrate and advised to reduce high-oxalate foods, he continued to consume large amounts of walnuts daily as part of his wellness routine and cultural beliefs. Discussion: This case highlights the risk of oxalate nephropathy associated with excessive intake of oxalate rich foods promoted by wellness trends. In patients with underlying chronic kidney disease, such practices can precipitate irreversible kidney injury. Early recognition and patient education regarding the avoidance of high-content foods and specific over-the-counter supplements may help prevent recurrence of similar clinical scenarios in individuals with chronic kidney disease.