An Often-Forgotten Entity: Oxalate Nephropathy Secondary to Pancreatitis

Introduction: Oxlate Nephropathy (ON) can present as acute or chronic renal failure and rarely as rapidaly progressive renal failure (RPRF) .Here we present a case of ON who presented as RPRF, in the background history necrotizing pancreatitis. Case Description: A 40-year-old male presented in April 2025 with RPRF,creatinine 7.24mg/dl (baseline 1.8 mg/dL ). Urine examination showed protein 1+ & 8-10 rbc's/hpf. USG revealed normal-sized kidneys with increased echogenicity. Renal biopsy -LM showed 12 normal glomeruli. The tubulointerstitial compartment exhibited patchy acute tubular injury, with numerous tubules containing extensive deposits of refractile and polarizable calcium oxalate crystals (Image A) with focal giant cell reaction. IFTA was 30–35%. IF showed 3+ albumin staining along the tubular basement membrane. 24-hour urinary oxalate excretion was 41.4 mg. Background history revealed that a- year ago, he suffered from acute necrotizing pancreatitis and AKI and required dialysis support. Later serum creatinine settled to 1.8 mg/dl. He was advised lifelong pancreatic enzyme replacement therapy, but he missed his medicines in the last two months. MRCP revealed an atrophic pancreas with areas of calcification and a walled-off necrotic collection in the antero-inferior peripancreatic region, with peripheral rim calcification. Patient's management included reintroduction of pancreatic enzyme supplementation, pyridoxine, urine alkalinization, and a short course of corticosteroids. This treatment resulted in a gradual improvement in renal function, with a progressive decline in serum creatinine levels to 4.7 mg/dL. Discussion: This case illustrates that chronic pancreatitis can lead to ON with presentation as RPRF. Case also underscores the importance of continuing pancreatic enzyme therapy in cases of chronic pancreatitis.