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Pancreatic insufficiency as a complication of type 1 diabetes causing enteric hyperoxaluria in a transplant kidney
  1. Joshua Chambers,
  2. Alice Appleton and
  3. Christopher Dudley
  1. Renal Medicine, North Bristol NHS Trust, Bristol, UK
  1. Correspondence to Dr Joshua Chambers; josh.chambers{at}


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.

  • Renal system
  • Diabetes
  • Renal transplantation
  • Acute renal failure
  • Vitamins and supplements

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  • Contributors The authors of this case study are as follows: JC, AA and CD. JC is the primary author of the case study and collected data from the two main electronic patient record systems ICE and Renal Proton. These data were collected, anonymised and saved onto hospital computer systems. All data collection complies with the requirements of the Data Protection Act (1998) and the General Data Protection Regulation with regard to the collection, storage, processing and disclosure of personal information. JC also wrote the primary draft and edits of the case study with AA and CD. JC also submitted this case study and is the corresponding author. AA, with JC and CD, drafted the first and subsequent copies of the case study and did the bulk of the literature review. CD is the consultant physician who looked after the patient, ordered investigations and treated the patient after the results of the renal biopsy; helped draft and edit the case study; and was the senior physician who oversaw this case study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.