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Calcium oxalate crystal deposition in the kidney: identification, causes and consequences

Lookup NU author(s): Dr Rob GeraghtyORCiD, Dr Katrina Wood, Professor John SayerORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Calcium oxalate (CaOx) crystal deposition within the tubules is often a perplexing finding on renal biopsy of both native and transplanted kidneys. Understanding the underlying causes may help diagnosis and future management. The most frequent cause of CaOx crystal deposition within the kidney is hyperoxaluria. When this is seen in native kidney biopsy, primary hyperoxaluria must be considered and investigated further with biochemical and genetic tests. Secondary hyperoxaluria, for example due to enteric hyperoxaluria following bariatric surgery, ingested ethylene glycol or vitamin C overdose may also cause CaOx deposition in native kidneys. CaOx deposition is a frequent finding in renal transplant biopsy, often as a consequence of acute tubular necrosis and is associated with poorer long-term graft outcomes. CaOx crystal deposition in the renal transplant may also be secondary to any of the causes associated with this phenotype in the native kidney. The pathophysiology underlying CaOx deposition is complex but this histological phenotype may indicate serious underlying pathology and should always warrant further investigation.

Publication metadata

Author(s): Geraghty R, Wood K, Sayer JA

Publication type: Article

Publication status: Published

Journal: Urolithiasis

Year: 2020

Volume: 48

Pages: 377-384

Print publication date: 01/10/2020

Online publication date: 27/07/2020

Acceptance date: 17/07/2020

Date deposited: 14/12/2020

ISSN (print): 2194-7228

ISSN (electronic): 2194-7236

Publisher: Springer


DOI: 10.1007/s00240-020-01202-w


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