Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

Hyperoxaluria Hyperphosphatemia 757

Routine

■monitor renal function regularly (frequency determined on individ-

ual basis)

complications and prognosis

Complications

■PHI: recurrent urolithiasis

■end-stage renal disease in nearly all if untreated (50% by age 15 years,

80% by age 30 years)

■recurrent disease in 100% if renal transplant alone (15–25% 3-year

graft survival)

■systemic oxalate deposition (e.g., liver, brain not affected)

■pathologic fractures

■cardiac conduction defect: sudden death

■PHII: may have recurrent urolithiasis

■may be asymptomatic

Prognosis

■PHI: end-stage renal disease in 50% by 15 years

■80% 5 year survival with combined liver/kidney transplant, 70% at

10 years

■15–25% 3 year survival of graft if kidney only transplant

■reversal of systemic storage in bone, heart, vessels, nerve after liver

transplant

■PHII: considered more benign that PHI, but end-stage renal disease

may develop (12% of patients 23–50 years)

■outcome of organ transplantation unknown

Hyperphosphatemia..................................

SHARON M. MOE, MD

history & physical

History

■Renal failure

■Tumor lysis syndrome

■Rhabdomyolysis

Signs & Symptoms

■Asymptomatic unless hypocalcemia occurs leading to tetany, or with

metastatic calcification due to precipitation of insoluble calcium

phosphorus complexes and decreased calcitrol synthesis