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Clin Nephrol. 2017 Dec;88(12):354-358. doi: 10.5414/CN109118.

Oxalate nephropathy following vitamin C intake within intensive care unit
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Abstract

OBJECTIVE:

To report a case of acute oxalate nephropathy related to vitamin C intake within the intensive care unit (ICU).

DESIGN:

Case report.

SETTING:

ICU and nephrology department of a French university hospital.

PATIENT:

A 57-year-old woman with septic shock related to <italic>Legionella pneumophila</italic> pneumonia complicated by acute respiratory distress syndrome and acute kidney injury who required renal replacement therapy for 75 days.

MEASUREMENTS AND MAIN RESULTS:

A renal biopsy was performed on day 72 because of persistent anuria and because the patient showed characteristic features of severe acute oxalate nephropathy. The only cause identified was vitamin C intake received during hospitalization within the ICU (~ 30 g over 2.5 months). At month 6 after ICU admission, estimated glomerular filtration rate was 24 mL/min/1.73m<sup>2</sup>.

CONCLUSION:

Compelling evidence obtained from in-vitro and animal studies suggest that vitamin C, a circulating antioxidant, may be a valuable adjunctive therapy in critically-ill patients. Data from humans are more conflicting. Oxalate, a well-known metabolite of vitamin C, is excreted by the kidneys and can exert a toxic effect on epithelial cells and causes direct tubular damage, and/or it can crystallize within the tubular lumen. This case highlights an under-recognized secondary adverse event from vitamin C given to critically-ill patients. The use of high-dose vitamin C should be prescribed with caution in this population.
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PMID:
29092737
DOI:
10.5414/CN109118
[Indexed for MEDLINE]

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