Rush University Medical Center Chicago, IL, United States
Matthew M. Eganhouse, MD, Salina Lee, MD Rush University Medical Center, Chicago, IL
Introduction: Primary Hyperoxaluria Type I (PH) is a genetic disorder that results in calcium oxalate stone formation leading to chronic renal failure and ESRD, among other complications. In this report, we describe a case of a patient with PH who presents to GI clinic for weight loss and was evaluated with esophagogastroduodenoscopy (EGD). Calcium phosphate crystal deposition was found, as opposed to calcium oxalate crystals as expected.This could have implications for ESRD patients with weight loss given the known phenomenon of calcium phosphate deposition in ESRD patients.
Case Description/Methods: 34 yo M with a history of PH, ESRD on HD secondary to renal calcinosis s/p bilateral nephrectomy, GERD, who presented to the GI clinic for weight loss. Patient had endorsed 30-40 pounds of weight loss over a 3 year period. He denied nausea, vomiting, early satiety, constipation at that time. He did have occasional loose stools but no significant diarrhea. He underwent EGD for evaluation, which found thickened, firm, gastric folds and erythematous and friable duodenal bulb. Pathology from biopsies of stomach and duodenum significant for clusters of macrophages with calcium phosphate crystal deposits in the lamina propria of the stomach and duodenum. Staining for H Pylori was negative. Random duodenal biopsies were unremarkable.
Discussion: PH is a genetic disorder that leads to ESRD, among other complications, from calcium oxalate stone formation. This patient with weight loss had a calcified stomach secondary to calcium phosphate crystal deposits with known recent hypercalcemia. Patients with ESRD are prone to vascular calcification from calcium phosphate crystal deposition, but calcification of the GI tract is not a well known phenomenon in these patients. Weight loss in ESRD patients is thought to be due to protease induction from chronic inflammation as well as malnutrition. Of note, during period of weight loss patient was found to be hypercalcemic at his dialysis center and taken off of Vitamin D and Sevalemer. It is also surprising in this patient given his propensity for calcium oxalate formation,[and while this was not the crystal found, perhaps this underlying comorbidity contributed to the development of calcium phosphate crystal deposition]. This finding in this patient could implicate luminal calcium phosphate deposition of the GI tract as another contributing source for weight loss and malnutrition in ESRD patients.
Disclosures: Matthew Eganhouse indicated no relevant financial relationships. Salina Lee indicated no relevant financial relationships.
Matthew M. Eganhouse, MD, Salina Lee, MD. P2054 - Gastrointestinal Calcium Phosphate Crystal Deposition in a Patient With Primary Hyperoxaluria, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.