{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T06:10:20Z","timestamp":1756275020709,"version":"3.44.0"},"reference-count":18,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,6,16]]},"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:p>A kidney transplant recipient with a medical history of type 1 diabetes mellitus (T1DM) presents to the clinic with an acute kidney injury (AKI) and diarrhoea. Kidney biopsy found deposition of focal oxalate crystals, and further investigation revealed a raised 24-hour urinary oxalate and reduced faecal elastase. Therefore, we present a case of acute oxalate nephropathy (AON) secondary to enteric hyperoxaluria as a result of pancreatic insufficiency caused by T1DM. T1DM is a common cause of end-stage renal failure and exocrine pancreatic insufficiency. Therefore, AON secondary to enteric hyperoxaluria should be considered in patients with a transplant AKI. Earlier testing of 24-hour urinary oxalate and faecal elastase could generate diagnosis before biopsy results and allow commencement of pancreatic replacement therapy earlier to avoid permanent loss of kidney function.<\/jats:p>","DOI":"10.1136\/bcr-2021-248162","type":"journal-article","created":{"date-parts":[[2022,7,4]],"date-time":"2022-07-04T12:10:19Z","timestamp":1656936619000},"page":"e248162","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Pancreatic insufficiency as a complication of type 1 diabetes causing enteric hyperoxaluria in a transplant kidney"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4849-9966","authenticated-orcid":false,"given":"Joshua","family":"Chambers","sequence":"first","affiliation":[{"name":"Renal Medicine, North Bristol NHS Trust, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alice","family":"Appleton","sequence":"additional","affiliation":[{"name":"Renal Medicine, North Bristol NHS Trust, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Dudley","sequence":"additional","affiliation":[{"name":"Renal Medicine, North Bristol NHS Trust, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,7,4]]},"reference":[{"key":"2025082622455917000_15.7.e248162.1","first-page":"287","article-title":"Secondary hyperoxaluria due to pancreatic insufficiency","volume":"77","author":"de Martines","year":"2019","journal-title":"Neth J Med"},{"key":"2025082622455917000_15.7.e248162.2","doi-asserted-by":"crossref","first-page":"487-495","DOI":"10.2215\/CJN.08000520","article-title":"Pathophysiology and treatment of enteric hyperoxaluria","volume":"16","author":"Witting","year":"2021","journal-title":"Clin J Am Soc Nephrol"},{"key":"2025082622455917000_15.7.e248162.3","doi-asserted-by":"publisher","DOI":"10.3109\/00365527809181767"},{"key":"2025082622455917000_15.7.e248162.4","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.02940608"},{"key":"2025082622455917000_15.7.e248162.5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2011\/761950","article-title":"Exocrine pancreatic insufficiency in diabetes mellitus: a complication of diabetic neuropathy or a different type of diabetes?","volume":"2011","author":"Hardt","year":"2011","journal-title":"Exp Diabetes Res"},{"key":"2025082622455917000_15.7.e248162.6","unstructured":"Hambling C , Cummings M , Merriman H . Gastrointestinal disorders in diabetes\u2014could it be pancreatic exocrine insufficiency?. [Online] Guidelines. Available: https:\/\/www.guidelines.co.uk\/diabetes\/pancreatic-exocrine-insufficiency-guideline\/454173.article [Accessed 7 Mar 2021]."},{"key":"2025082622455917000_15.7.e248162.7","doi-asserted-by":"crossref","unstructured":"Knight J , Madduma-Liyanage K , Mobley JA , et al . Ascorbic acid intake and oxalate synthesis 2016;44:289\u201397.","DOI":"10.1007\/s00240-016-0868-7"},{"key":"2025082622455917000_15.7.e248162.8","doi-asserted-by":"crossref","first-page":"1484","DOI":"10.3390\/jcm10071484","article-title":"Acute kidney injury (AKI) before and after kidney transplantation: causes, medical approach, and implications for the long-term outcomes","volume":"10","author":"Palmisano","year":"2021","journal-title":"J Clin Med"},{"key":"2025082622455917000_15.7.e248162.9","first-page":"631","article-title":"Acute kidney injury: a guide to diagnosis and management","volume":"86","author":"Rahman","year":"2012","journal-title":"Am Fam Physician"},{"key":"2025082622455917000_15.7.e248162.10","unstructured":"Naik R , Shawar S . Renal Transplantation Rejection. StatPearls [Internet]. [Online] StatPearls Publishing, 2021. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK553074\/"},{"key":"2025082622455917000_15.7.e248162.11","first-page":"1","volume-title":"Case Reports in Transplantation. [Online] Hindawi Publishing Corporation","volume":"2013","author":"Jantz","year":"2013"},{"key":"2025082622455917000_15.7.e248162.12","doi-asserted-by":"crossref","first-page":"S68","DOI":"10.2215\/CJN.02770707","article-title":"Bk virus nephritis after renal transplantation","volume":"3 Suppl 2","author":"Dall","year":"2008","journal-title":"Clin J Am Soc Nephrol"},{"key":"2025082622455917000_15.7.e248162.13","doi-asserted-by":"publisher","DOI":"10.2337\/dc18-1936"},{"key":"2025082622455917000_15.7.e248162.14","doi-asserted-by":"crossref","first-page":"7059","DOI":"10.3748\/wjg.v23.i39.7059","article-title":"Less common etiologies of exocrine pancreatic insufficiency","volume":"23","author":"Singh","year":"2017","journal-title":"World J Gastroenterol"},{"key":"2025082622455917000_15.7.e248162.15","first-page":"28","article-title":"Diabetes and end-stage renal disease; a review article on new concepts","volume":"4","author":"Ghaderian","year":"2015","journal-title":"J Renal Inj Prev"},{"key":"2025082622455917000_15.7.e248162.16","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1016\/j.ekir.2018.07.020","article-title":"Secondary Oxalate Nephropathy: A\u00a0Systematic Review","volume":"3","author":"Lumlertgul","year":"2018","journal-title":"Kidney Int Rep"},{"key":"2025082622455917000_15.7.e248162.17","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/0272-6386(95)90156-6","article-title":"Rapid renal deterioration secondary to oxalate in a patient with diabetic gastroenteropathy","volume":"26","author":"Crook","year":"1995","journal-title":"Am J Kidney Dis"},{"key":"2025082622455917000_15.7.e248162.18","doi-asserted-by":"publisher","DOI":"10.1097\/MPA.0000000000000609"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-248162","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T05:46:08Z","timestamp":1756273568000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-248162"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7]]},"references-count":18,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2022,7,4]]},"published-print":{"date-parts":[[2022,7]]}},"alternative-id":["10.1136\/bcr-2021-248162"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-248162","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2022,7]]}}}