Oxalosis Associated With High-Dose Vitamin C Ingestion in a Peritoneal Dialysis Patient

Matthew R. D'Costa, Nelson S. Winkler, Dawn S. Milliner, Suzanne M. Norby, LaTonya Hickson, John C Lieske

Research output: Contribution to journalArticle

Abstract

We report a case of systemic oxalosis involving the eyes and joints due to long-term use of high-dose vitamin C in a patient receiving maintenance peritoneal dialysis (PD). This 76-year-old woman with autosomal dominant polycystic kidney disease underwent living unrelated kidney transplantation 10 years earlier. The transplant failed 6 months before presentation, and she initiated hemodialysis therapy before transitioning to PD therapy 4 months later. During the month before presentation, the patient noted worsening arthralgias and decreased vision. Ophthalmologic examination revealed proliferative retinopathy and calcium oxalate crystals. Plasma oxalate level was markedly elevated at 187 (reference range, <1.7) μmol/L, and urine oxalate-creatinine ratio was high (0.18 mg/mg). The patient reported taking up to 4 g of vitamin C per day for several years. Workup for causes of primary and secondary hyperoxaluria was otherwise negative. Vitamin C use was discontinued, and the patient transitioned to daily hemodialysis for 2 weeks. Plasma oxalate level before the dialysis session decreased but remained higher (30-53 μmol/L) than typical for dialysis patients. Upon discharge, the patient remained on thrice-weekly hemodialysis therapy with stabilized vision and improved joint symptoms. This case highlights the risk of high-dose vitamin C use in patients with advanced chronic kidney disease, especially when maintained on PD therapy.

Original languageEnglish (US)
JournalAmerican Journal of Kidney Diseases
DOIs
StatePublished - Jan 1 2019

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Hyperoxaluria
Peritoneal Dialysis
Ascorbic Acid
Eating
Oxalates
Renal Dialysis
Dialysis
Joints
Primary Hyperoxaluria
Autosomal Dominant Polycystic Kidney
Calcium Oxalate
Arthralgia
Therapeutics
Chronic Renal Insufficiency
Kidney Transplantation
Creatinine
Reference Values
Maintenance
Urine
Transplants

Keywords

  • Ascorbic acid
  • case report
  • dialytic clearance
  • oxalate removal
  • oxalosis
  • peritoneal dialysis (PD)
  • retinopathy
  • supplements
  • vision loss
  • vitamin C

ASJC Scopus subject areas

  • Nephrology

Cite this

Oxalosis Associated With High-Dose Vitamin C Ingestion in a Peritoneal Dialysis Patient. / D'Costa, Matthew R.; Winkler, Nelson S.; Milliner, Dawn S.; Norby, Suzanne M.; Hickson, LaTonya; Lieske, John C.

In: American Journal of Kidney Diseases, 01.01.2019.

Research output: Contribution to journalArticle

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