Hyperoxaluria is a condition that occurs when there is too much oxalate in your urine. Kidney stones are usually the first symptom. The goal of treatment is to lower the level of oxalate in the body and prevent calcium oxalate crystals from forming in the kidneys and other body tissues. Cleveland Clinic reviews types of hyperoxaluria, treatment options, who to screen for the condition and more.
Hyperoxaluria is a condition that occurs when there is too much oxalate in your urine. Oxalate, a natural chemical in your body and also contained in some foods, is normally eliminated from the body through the kidneys in the urine (and can also be eliminated through stool).
Too much oxalate in the body can cause some serious health problems. An excess amount of oxalate can combine with calcium in the urine and cause kidney stones and crystals to form. Recurrent kidney stones and crystals can damage the kidney and lead to kidney failure. In addition, if the kidneys begin to fail and can’t eliminate excess oxalate, eventually oxalate crystals can build up in other areas of the body and cause bone disease; blood problems (anemia); heart, skin and eye problems and growth and development problems in children. When oxalate builds up in the body’s tissues, the condition is called systemic oxalosis.
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Symptoms of hyperoxaluria can develop anytime from infancy to later adulthood (over 70 years of age). The most common initial symptom is usually kidney stones. However, initial symptoms can vary from mild to severe. In some patients, kidney failure is the first symptom.
It is estimated that about 5,000 patients in the United States have primary hyperoxaluria. Patients with primary hyperoxaluria typically develop kidney stones by the age of 20. If babies develop primary hyperoxaluria (rare), the condition tends to be severe. About 50 percent of patients with primary hyperoxaluria experience kidney failure by age 15; about 80 percent will experience kidney failure by age 30. Older children and adults who develop primary hyperoxaluria tend to have better outcomes. The course of the condition varies with each individual.
It is estimated that about 200,000 to 250,000 people in the United States have secondary hyperoxaluria (see "causes" section).
Kidney stones are usually the first symptom. Signs and symptoms of kidney stones include:
There are two types of hyperoxaluria, primary hyperoxaluria and secondary hyperoxaluria.
In addition to a physical exam, medical history, and diet history, typical tests used to diagnose hyperoxaluria include:
If kidney stone(s) are found and surgically removed or passed without surgery, an analysis of the makeup of the stone may be done.
Other tests may be done to determine if there are oxalate deposits in other organs and tissues. These tests include:
If your doctor suspects primary hyperoxaluria, he or she may also do genetic testing to determine if you have a gene mutation.
The goal of treatment is to lower the level of oxalate in the body and prevent calcium oxalate crystals from forming in the kidneys and other body tissues. Certain treatments are recommended for primary hyperoxaluria (PH) and for secondary hyperoxaluria (SH). These treatments include:
If a kidney stone is present, the stone may be able to pass on its own by drinking a lot of water. If your kidney stone does not pass on its own, a procedure may be performed to remove the stone. Possible procedures include shock wave lithotripsy, ureteroscopy, or percutaneous nephrolithotomy. Your doctor will discuss which method is best for your situation if stone removal is needed.
If hyperoxaluria is severe, your kidneys may stop working. When this happens, kidney dialysis or organ transplantation (kidney or liver-kidney combination transplant) will be needed. The type of transplant depends on the specific type of primary hyperoxaluria. There is limited data on the role of transplant for patients with secondary hyperoxaluria. Your doctor will discuss all treatment options with you.
The following patients are at greater risk of hyperoxaluria and therefore should be evaluated for this condition:
Genetic testing should be offered if your brothers or sisters have been diagnosed with primary hyperoxaluria. (Parents may not have symptoms of the condition but can pass the genetic defect to their children, and one or more children may develop the condition.)
If you have been diagnosed with primary hyperoxaluria (an inherited condition), hyperoxaluria cannot be prevented. If someone in your family has been diagnosed with hyperoxaluria, you can be screened for this gene defect. Treatment can be started before any symptoms or organ damage occurs. To reduce the chance of recurrent kidney stones, chronic kidney disease or end-stage kidney disease, patients with secondary hyperoxaluria should follow the treatment plan outlined by your doctor.
Untreated hyperoxaluria can eventually lead to kidney damage and even kidney failure and death. Depending on its severity, dialysis and organ transplant may be needed. In addition, oxalate crystals can build up in other areas of the body and cause bone disease; blood problems (anemia); heart, skin and eye problems and growth and development problems in children. Because of these complications, prompt diagnosis and early treatment is important to the prognosis.
There is no cure for primary hyperoxaluria. The goal is to protect the kidneys by preventing the development of kidney stones and prevent calcium oxalate from forming and depositing in other body tissues.
Your doctor will talk with you about your particular type of hyperoxaluria and provide a treatment plan to best manage your condition.
It is critical that people living with hyperoxaluria follow their doctor’s treatment plan and have regular clinical exams with their urologist or primary care provider.
Last reviewed by a Cleveland Clinic medical professional on 03/27/2019.
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