Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2016 Apr;5(2):79-83.
doi: 10.15171/jnp.2016.14. Epub 2016 Mar 29.

Acute oxalate nephropathy associated with orlistat

Youshay Humayun  1 , Kenneth C Ball  1 , Jack R Lewin  2 , Anna A Lerant  3 , Tibor Fülöp  1
Affiliations
Case Reports

Acute oxalate nephropathy associated with orlistat

Youshay Humayun et al. J Nephropathol. 2016 Apr.

Abstract

Background: Obesity is a major world-wide epidemic which has led to a surge of various weight loss-inducing medical or surgical treatments. Orlistat is a gastrointestinal lipase inhibitor used as an adjunct treatment of obesity and type 2 diabetes mellitus to induce clinically significant weight loss via fat malabsorption.

Case presentation: We describe a case of a 76-year-old female with past medical history of chronic kidney disease (baseline serum creatinine was 1.5-2.5 mg/dL), hypertension, gout and psoriatic arthritis, who was admitted for evaluation of elevated creatinine, peaking at 5.40 mg/dL. She was started on orlistat 120 mg three times a day six weeks earlier. Initial serologic work-up remained unremarkable. Percutaneous kidney biopsy revealed massive calcium oxalate crystal depositions with acute tubular necrosis and interstitial inflammation. Serum oxalate level returned elevated at 45 mm/l (normal <27). Timed 24-hour urine collection documented increased oxalate excretion repeatedly (54-96 mg/24 hour). After five renal dialysis sessions in eighth days she gradually regained her former baseline kidney function with creatinine around 2 mg/dL. Given coexisting proton-pump inhibitor therapy, only per os calcium-citrate provided effective intestinal oxalate chelation to control hyperoxaluria.

Conclusions: Our case underscores the potential of medically induced fat malabsorption to lead to an excessive oxalate absorption and acute kidney injury (AKI), especially in subjects with pre-existing renal impairment. Further, it emphasizes the importance of kidney biopsy to facilitate early diagnosis and treatment.

Keywords: Acute kidney injury; Dialysis; Orlistat; Oxalate nephropathy; Proton-pump inhibitor; Weight loss supplement.

PubMed Disclaimer

Figures

Figure 1
Figure 1
See this image and copyright information in PMC

Comment in

References

    1. Nasr SH, D’Agati VD, Said SM, Stokes MB, Largoza MV, Radhakrishnan J. et al. Oxalate nephropathy complicating Roux-en-Y gastric bypass: an underrecognized cause of irreversible renal failure. Clin J Am Soc Nephrol. 2008;3(6):1676–83. doi: 10.2215/cjn.02940608. - DOI - PMC - PubMed
    1. Mascio HM, Joya CA, Plasse RA, Baker TP, Flessner MF, Nee R. An unusual cause of acute kidney injury due to oxalate nephropathy in systemic scleroderma. Clin Nephrol. 2015;84(8):111–5. doi: 10.5414/CN108406. - DOI - PubMed
    1. Rankin A, Walsh S, Summers S, Owen M, Mansell M. Acute oxalate nephropathy causing late renal transplant dysfunction due to enteric hyperoxaluria. Am J Transplant. 2008;8(8):1755–8. doi: 10.1111/j.1600-6143.2008.02288.x. - DOI - PubMed
    1. Singh A, Sarkar SR, Gaber LW, Perazella MA. Acute oxalate nephropathy associated with orlistat, a gastrointestinal lipase inhibitor. Am J Kidney Dis. 2007;49(1):153–7. - PubMed
    1. Karamadoukis L, Shivashankar G, Ludeman L, Williams A. An unusual complication of treatment with orlistat. Clin Nephrol. 2009;71(4):430–2. doi: 10.5414/CNP71430. - DOI - PubMed

Publication types

LinkOut - more resources