Primary Hyperoxaluria - The German Experience
Bernd Hoppe^a, Kay Latta^b, Christian von Schnakenburg^c, Markus J. Kemper^d, on behalf of the Arbeitsgemeinschaft für pädiatrische Nephrologie<sup>1

a</sup>Division of Pediatric Nephrology, Children's Hospital Cologne, University of Cologne, Cologne;
^bClementine Children's Hospital Frankfurt, Frankfurt; Division of Pediatric Nephrology, University Children's Hospitals,
^cFreiburg and
^dHamburg, Germany

Address of Corresponding Author

Am J Nephrol 2005;25:276-281 (DOI: 10.1159/000086358)

  Key Words

• Primary hyperoxaluria, epidemiology
• Primary hyperoxaluria, diagnosis
• Primary hyperoxaluria, treatment and outcome
• Oxalate

  Abstract

Background: Primary hyperoxaluria (PH) is a heterogeneous disease with variable age of onset and inconsistent progression into renal failure (ESRF). Aims: In 1994 we initiated a survey within our Pediatric Nephrology working group to ascertain epidemiologic data and current practices. Updates were performed in 2000 and 2004. Results: Diagnosis of PH was made in 65 patients (42 with PH type I, 3 with PH type II, 12 unclassified and 8 reported dead), which suggests a minimum prevalence of 0.7 per 1 million of the population. First symptoms were urolithiasis, nephrocalcinosis, urinary tract infection or hematuria. Diagnosis was often delayed and was made only in ESRF in 11% of patients. Measurement of urine metabolites or plasma oxalate in ESRF was performed in 76 and 57%, respectively. Determination of enzyme activity in liver biopsy (55% overall) and mutation analysis have increasingly been performed since 2000 (84.2 and 51%). Treatment included high fluid intake, pyridoxine, citrate and magnesium preparations. Pyridoxine response was reported in 21% of patients. No genotype/phenotype correlation was seen. Most patients (39) do not require renal replacement therapy, 5 patients receive chronic hemodialysis. Preemptive liver (n = 5) and combined liver-kidney transplantation (n = 9) were the preferred transplantation procedures. Conclusion: Despite increasing knowledge and awareness, diagnosis of PH is still too often delayed and diagnosis only made in ESRF. Most German patients, however, do currently not require renal replacement therapy. Genotype/phenotype correlations were not found. Combined liver kidney transplantation is the preferred procedure, but has its specific risks. Additional treatment options are clearly needed.

Copyright © 2005 S. Karger AG, Basel

  Author Contacts

Bernd Hoppe, MD
University Children's Hospital, Division of Pediatric Nephrology, University of Cologne
Kerpenerstrasse 62
D-50931 Cologne (Germany)
Tel. +49 221 4784391, Fax +49 221 4785835, E-Mail bernd.hoppe@uk-koeln.de

  Article Information

Received: April 14, 2005
Accepted: May 9, 2005
Published online: June 15, 2005
Number of Print Pages : 6
Number of Figures : 1, Number of Tables : 2, Number of References : 20