Statistics

 array:21 [
  "pii" => "X2013251411051547"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2010.Nov.10725"
  "estado" => "S300"
  "fechaPublicacion" => "2011-03-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia (English Version). 2011;31:227-9"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 5286
    "formatos" => array:3 [
      "EPUB" => 336
      "HTML" => 4297
      "PDF" => 653
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X021169951105154X"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2010.Nov.10725"
      "estado" => "S300"
      "fechaPublicacion" => "2011-03-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2011;31:227-9"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 7696
        "formatos" => array:3 [
          "EPUB" => 321
          "HTML" => 6731
          "PDF" => 644
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "titulo" => "Hiperoxaluria primaria de diagnóstico tardío en paciente joven con insuficiencia renal crónica avanzada"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "227"
            "paginaFinal" => "229"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Delayed diagnosis of primary hyperoxaluria in a young patient with advanced chronic renal failure"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig1"
            "etiqueta" => "Fig. 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "copyright" => "Elsevier España"
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "10725_108_10603_es_10725_f1.jpg"
                "Alto" => 514
                "Ancho" => 588
                "Tamanyo" => 151066
              ]
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "M. Martín, G. Martín Reyes, A. Torres de Rueda, R. Toledo Rojas, C. Jironda, I. García, T. García de la Oliva, M.L. Pérez Vaca, D. Hernández"
            "autores" => array:9 [
              0 => array:2 [
                "Iniciales" => "M."
                "apellidos" => "Martín"
              ]
              1 => array:2 [
                "Iniciales" => "G."
                "apellidos" => "Martín Reyes"
              ]
              2 => array:2 [
                "Iniciales" => "A."
                "apellidos" => "Torres de Rueda"
              ]
              3 => array:2 [
                "Iniciales" => "R."
                "apellidos" => "Toledo Rojas"
              ]
              4 => array:2 [
                "Iniciales" => "C."
                "apellidos" => "Jironda"
              ]
              5 => array:2 [
                "Iniciales" => "I."
                "apellidos" => "García"
              ]
              6 => array:2 [
                "Iniciales" => "T."
                "apellidos" => "García de la Oliva"
              ]
              7 => array:2 [
                "Iniciales" => "M.L."
                "apellidos" => "Pérez Vaca"
              ]
              8 => array:2 [
                "Iniciales" => "D."
                "apellidos" => "Hernández"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251411051547"
          "doi" => "10.3265/Nefrologia.pre2010.Nov.10725"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411051547?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X021169951105154X?idApp=UINPBA000064"
      "url" => "/02116995/0000003100000002/v0_201502091417/X021169951105154X/v0_201502091417/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X2013251411051539"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2010.Dec.10677"
    "estado" => "S300"
    "fechaPublicacion" => "2011-03-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2011;31:229-31"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 6946
      "formatos" => array:3 [
        "EPUB" => 345
        "HTML" => 5946
        "PDF" => 655
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Diagnosis of secondary hypertension causing miscarriage during the first trimester of pregnancy"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "229"
          "paginaFinal" => "231"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Diagnóstico de una hipertensión arterial secundaria en una gestante en el primer trimestre como causa de un aborto espontáneo"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Fig. 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier España"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "10677_108_15831_en_10677_18107_11652_es4881b5.jpg"
              "Alto" => 450
              "Ancho" => 600
              "Tamanyo" => 141290
            ]
          ]
          "descripcion" => array:1 [
            "en" => "MR of left adrenal gland"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "O. Fikri Benbrahim, R. García Agudo, F. Cazalla Cadenas, A. Martínez Calero, J. González-Spínola"
          "autores" => array:5 [
            0 => array:2 [
              "Iniciales" => "O."
              "apellidos" => "Fikri Benbrahim"
            ]
            1 => array:2 [
              "Iniciales" => "R."
              "apellidos" => "García Agudo"
            ]
            2 => array:2 [
              "Iniciales" => "F."
              "apellidos" => "Cazalla Cadenas"
            ]
            3 => array:2 [
              "Iniciales" => "A."
              "apellidos" => "Martínez Calero"
            ]
            4 => array:2 [
              "Iniciales" => "J."
              "apellidos" => "González-Spínola"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699511051531"
        "doi" => "10.3265/Nefrologia.pre2010.Dec.10677"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699511051531?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411051539?idApp=UINPBA000064"
    "url" => "/20132514/0000003100000002/v0_201502091641/X2013251411051539/v0_201502091641/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251411051563"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2010.Dec.10753"
    "estado" => "S300"
    "fechaPublicacion" => "2011-03-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia (English Version). 2011;31:225-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5036
      "formatos" => array:3 [
        "EPUB" => 310
        "HTML" => 4229
        "PDF" => 497
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "A patient with acute renal failure and episcleritis, is there more than meets the eye?"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "225"
          "paginaFinal" => "226"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Paciente con insuficiencia renal aguda y episcleritis, ¿hay en ello más de lo que se ve?"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Fig. 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier España"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "10753_108_11307_en_10753_f1.jpg"
              "Alto" => 174
              "Ancho" => 600
              "Tamanyo" => 76141
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Subconjunctival bleeding due to difuse episcleritis."
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A.P. Bernardo, J.M. Montalbán, E. Rocha"
          "autores" => array:4 [
            0 => null
            1 => array:2 [
              "Iniciales" => "A.P."
              "apellidos" => "Bernardo"
            ]
            2 => array:2 [
              "Iniciales" => "J.M."
              "apellidos" => "Montalbán"
            ]
            3 => array:2 [
              "Iniciales" => "E."
              "apellidos" => "Rocha"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699511051566"
        "doi" => "10.3265/Nefrologia.pre2010.Dec.10753"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699511051566?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411051563?idApp=UINPBA000064"
    "url" => "/20132514/0000003100000002/v0_201502091641/X2013251411051563/v0_201502091641/en/main.assets"
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "titulo" => "Delayed diagnosis of primary hyperoxaluria in a young patient with advanced chronic renal failure"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "227"
        "paginaFinal" => "229"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "M. Martín, G. Martín Reyes, A. Torres de Rueda, R. Toledo Rojas, C. Jironda, I. García, T. García de la Oliva, M.L. Pérez Vaca, D. Hernández"
        "autores" => array:9 [
          0 => array:3 [
            "Iniciales" => "M."
            "apellidos" => "Martín"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:4 [
            "Iniciales" => "G."
            "apellidos" => "Mart&#237;n Reyes"
            "email" => array:1 [
              0 => "gmartinr&#64;senefro&#46;org"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          2 => array:3 [
            "Iniciales" => "A."
            "apellidos" => "Torres de Rueda"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          3 => array:3 [
            "Iniciales" => "R."
            "apellidos" => "Toledo Rojas"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          4 => array:3 [
            "Iniciales" => "C."
            "apellidos" => "Jironda"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          5 => array:3 [
            "Iniciales" => "I."
            "apellidos" => "Garc&#237;a"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          6 => array:3 [
            "Iniciales" => "T."
            "apellidos" => "Garc&#237;a de la Oliva"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "affc"
              ]
            ]
          ]
          7 => array:3 [
            "Iniciales" => "M.L."
            "apellidos" => "P&#233;rez Vaca"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "affd"
              ]
            ]
          ]
          8 => array:3 [
            "Iniciales" => "D."
            "apellidos" => "Hern&#225;ndez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "Servicio de Nefrología, Hospital Regional Universitario Carlos Haya, Málaga,   "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
          1 => array:3 [
            "entidad" => "Servicio Anatomía Patológica, Hospital Regional Universitario Carlos Haya, Málaga,   "
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "affb"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Radiología, Hospital Regional Universitario Carlos Haya, Málaga,   "
            "etiqueta" => "<span class="elsevierStyleSup">c</span>"
            "identificador" => "affc"
          ]
          3 => array:3 [
            "entidad" => "Servicio de Hematología, Hospital Regional Universitario Carlos Haya, Málaga,   "
            "etiqueta" => "<span class="elsevierStyleSup">d</span>"
            "identificador" => "affd"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Hiperoxaluria primaria de diagn&#243;stico tard&#237;o en paciente joven con insuficiencia renal cr&#243;nica avanzada"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "10725_108_15829_en_10725f1.jpg"
            "Alto" => 696
            "Ancho" => 600
            "Tamanyo" => 232297
          ]
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#44; </span></p><p class="elsevierStylePara">Primary hyperoxaluria &#40;PHO&#41; is a fairly rare metabolic alteration&#46; Its annual incidence is 0&#46;11-0&#46;26&#47;100&#160;000 births and its prevalence is 1-2&#46;9&#47;1000&#160;000 inhabitants&#44; approximately&#46;<span class="elsevierStyleSup">1</span> In Spain&#44; there is a relatively high number of cases&#44; given its increased incidence on the Canary Islands &#40;especially La Gomera&#41;&#46;<span class="elsevierStyleSup">2</span> Diagnosis is usually delayed&#58; with an average interval of 3&#46;4 years between the onset of the symptoms and its diagnosis&#46; Only 30&#37; of cases are diagnosed early&#46;<span class="elsevierStyleSup">3</span> As such&#44; in most cases&#44; patients present with oxalate deposits in the definitive diagnosis&#44; even in the cardiovascular system&#44; which inevitably leads to death&#46; PHO is caused by an enzymatic defect located in the hepatocyte peroxisome&#44; which enhances glyoxylate conversion to poorly soluble oxalate&#46;<span class="elsevierStyleSup">4</span> The <span class="elsevierStyleItalic">AGXT </span>gene is affected in primary hyperoxaluria type I&#44; which is found in the chromosome 2q36-37&#46; It corresponds with the alanine-glyoxylate aminotransferase enzyme &#40;43kDa protein&#41;<span class="elsevierStyleSup">2</span>&#44; which needs vitamin B<span class="elsevierStyleInf">6</span> &#40;pyridoxine&#41; to function correctly&#46; Various mutations in the <span class="elsevierStyleItalic">AGXT </span>gene have been observed&#44; involving multiple defects&#44; among which the most frequent is the lack of immunoreactive and catalytic activity &#40;42&#37;&#41;&#46;<span class="elsevierStyleSup">5</span> The only treatment performed successfully in these patients is liver or liver and kidney transplant&#44; which may supplement enzymatic activity and kidney function&#44; respectively&#46;</p><p class="elsevierStylePara">We present the case of a 24-year-old Maghreb man&#44; with a history of chronic renal failure &#40;CRF&#41; secondary to nephrocalcinosis&#46; He presented with several infections&#44; two abscesses in the right psoas muscle and the left sternoclavicular joint&#44; although the aetiological origin could not be identified in either of the two cases&#46; In the same year he had a thalamic stroke and right perimesencephalic haemorrhage&#46; He was admitted to his area hospital with severely deteriorated condition&#44; with recurrent fever and episodes of arthritis in his right shoulder due to <span class="elsevierStyleItalic">S&#46; epidermis </span>and in his left sternoclavicular joint due to enterococcus&#46; Both were secondary to permanent catheter-related bacteraemia in the right jugular vein &#40;he previously presented with thrombosis in several vascular accesses&#41;&#46; During hospital stay &#40;which lasted a year&#41; numerous complications occurred&#58; chronic severe anaemia&#44; upper digestive haemorrhage&#44; uraemic pericarditis&#44; and pneumonia with pleural effusion&#46; In the last few weeks of the hospital stay&#44; he had left-side neck pains&#44; significantly limited functions&#44; fasciculations&#44; fever&#44; and negative blood culture tests&#46; Magnetic resonance imaging &#40;Figure 1&#41; was performed&#46; Secondary spondylodiscitis was suspected and the patient was referred to our health centre for a decompressive laminectomy&#46;</p><p class="elsevierStylePara">During the physical examination upon arrival&#44; we found deterioration of his general condition&#44; cachexia with muscular atrophy &#40;which prevented him from walking&#41;&#44; hypotension&#44; tachycardia and fever&#46; He had a normal heart rate and a pansystolic murmur with hypoventilation of the lung bases&#46; He had painless hepatosplenomegaly&#46; Both knees were swollen and the right shoulder was visibly swollen&#46;</p><p class="elsevierStylePara">Anaemia was discovered in the laboratory tests &#40;Hb&#58; 8&#46;3g&#47;dl&#41;&#44; leukocytosis&#58; 18&#160;900&#44; parathyroid hormone &#40;PTH&#41;&#58; 83pg&#47;ml and changes to inflammatory and nutritional parameters &#40;GGT&#58; 544IU&#47;l&#59; albumin&#58; 0&#46;7g&#47;dl and ferritin&#58; 5&#46;93ng&#47;ml PCR&#41;&#46; A bone scan was performed&#44; which showed signs of advanced secondary hyperthyroidism&#46; The main alterations can be seen in Figure 1&#46; The cervical CT revealed a significant kyphosis at the C5-C6 vertebral body height&#44; alteration in their morphology and a severe reduction in the antero-posterior diameter&#44; which significantly compressed the medulla at that point and caused foraminal stenosis&#46;</p><p class="elsevierStylePara">A biopsy and a bone marrow aspiration were performed which found multinucleated giant cells derived from monocyte macrophages containing oxalate crystals birefringent to polarised light&#46; In the bone marrow the medullar space had been substituted by concentrically disposed crystals&#44; grouped together in a star or rosette shape&#44; which were refringent to polarised light&#44; with peripheral reaction of giant cells and trabecular bone destruction &#40;Figure 2&#41;&#46; With these findings the patient was diagnosed with primary hyperoxaluria&#46; Palliative treatment with vitamin B and intensive dialysis was indicated&#44; but the patient died 30 days after hospitalisation&#46;</p><p class="elsevierStylePara">This case illustrates the harmful consequences associated with the delayed diagnosis of this rare disease&#44; which is fatal if aggressive treatment is not indicated early&#46; Current therapeutic alternatives for patients with CRF are palliative &#40;kidney transplant&#41; or curative&#44; although they have a high morbidity rate &#40;liver and kidney transplant&#41;&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">In 1997&#44; Hoppe found a very low PHO frequency in the dialysis population&#46; He observed delayed diagnosis in 42&#37; of the patients and 30&#37; were diagnosed when they already had end-stage kidney disease&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">The most common and earliest manifestations of the disease are nephrocalcinosis &#40;due to oxalate crystals forming in the kidney parenchyma&#41; and urolithiasis &#40;being excreted through the pyelocaliceal system&#41;&#46; Manifestations vary depending on the patient&#8217;s age&#46; In small children&#44; it is characterised by CRF with massive parenchymal oxalosis&#46; Older children present with symptoms of urolithiasis and in some cases&#44; complete obstruction with acute renal failure&#46; It often occurs with end-stage kidney disease in adult patients&#46;<span class="elsevierStyleSup">6</span> Unfortunately&#44; PHO diagnosis was delayed for our patient&#44; leading to his death&#46;</p><p class="elsevierStylePara">A simple method for detecting this disease can be measuring urinary oxalate excretion&#46; In normal conditions&#44; excretion is 0&#46;5mmol&#47;1&#46;73m<span class="elsevierStyleSup">2</span>&#47;day or 45mg&#47;1&#46;73m<span class="elsevierStyleSup">2</span>&#47;day&#46; People with PHO have a significant increase in urinary oxalate excretion &#40;&#62;1mmol&#47;1&#46;73m<span class="elsevierStyleSup">2</span>&#47;day or 90mg&#47;1&#46;73m<span class="elsevierStyleSup">2</span>&#47;day&#41;&#46;<span class="elsevierStyleSup">6</span> This excretion rate is less useful for kidney failure patients&#44; as in our case&#44; given that the patient already had advanced CRF&#46; In these cases&#44; the increase in plasma oxalate would help to reach a diagnosis&#44; alongside calcium oxalate in tissues&#44;<span class="elsevierStyleSup">7</span> although not all laboratories have this possibility&#46; A liver biopsy is the only test which confirms definitive diagnosis of PHO&#46; Depending on the laboratory&#44; it can provide information on whether there is immunoreactive protein or not &#40;Western blot&#41;&#44; subcellular localisation &#40;IF&#41; and even the type of mutation &#40;sequencing&#41;&#46;<span class="elsevierStyleSup">9 </span></p><p class="elsevierStylePara">In our case&#44; diagnosis was performed by biopsy and bone marrow aspiration&#46; As a general rule&#44; oxalate deposits appear in end-stage kidney failure&#44; developing more quickly during chronic haemodialysis&#46; These oxalate deposits with surrounding reaction provoke lesions similar to secondary hyperparathyroidism lesions<span class="elsevierStyleSup">8</span> and severe anaemia resistant to erythropoietin &#40;EPO&#41;&#44; as has been described previously&#46;<span class="elsevierStyleSup">10</span></p><p class="elsevierStylePara">Lastly&#44; we must stress the importance of detecting this disease early&#44; given that the effectiveness of treatment depends on how quickly it is diagnosed&#46; A delayed diagnosis leads to CRF and massive oxalate deposits in organs and tissues&#46; This must be considered for the population at risk&#58; i&#46;e&#46; people from the Canary Islands and Maghrebians&#46; The Canarian population with PHO are not Maghreb but Caucasian&#44; but given that it is an island&#44; a cross over has occurred&#46;</p><p class="elsevierStylePara"><a href="grande&#47;10725&#95;108&#95;15829&#95;en&#95;10725f1&#46;jpg" class="elsevierStyleCrossRefs"><img src="10725_108_15829_en_10725f1.jpg"></img></a></p><p class="elsevierStylePara">Figure 1&#46; </p><p class="elsevierStylePara"><a href="grande&#47;10725&#95;108&#95;15830&#95;en&#95;10725&#95;figura2&#46;jpg" class="elsevierStyleCrossRefs"><img src="10725_108_15830_en_10725_figura2.jpg"></img></a></p><p class="elsevierStylePara">Figure 2&#46; </p>"
    "pdfFichero" => "P1-E518-S2912-A10725-EN.pdf"
    "tienePdf" => true
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig1"
        "etiqueta" => "Fig. 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "10725_108_15829_en_10725f1.jpg"
            "Alto" => 696
            "Ancho" => 600
            "Tamanyo" => 232297
          ]
        ]
      ]
      1 => array:7 [
        "identificador" => "fig2"
        "etiqueta" => "Fig. 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "10725_108_15830_en_10725_figura2.jpg"
            "Alto" => 346
            "Ancho" => 600
            "Tamanyo" => 238709
          ]
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Levy M, Feingold J. Estimating prevalence in single gene kidney diseases progressing to renal failure. Kidney Int 2000;58:925. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10972657" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Santana A, Torres A, Salido E. Patología molecular de la hiperoxaluria primaria. Nefrologia\u{A0}2003;23(Supl 1):90. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12708368" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hoppe B, Langman CB. A United States Surrey on diagnosis, treatment, and outcome of primary hyperoxaluria. Pediatr Nephrol 2003;18:986. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12920626" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Danpure CJ. Metabolic and clinical heterogeneity of primary hyperoxaluria type I. Am J Kidney Dis 1991;17:366. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2008900" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Danpure CJ. Advances in the enzymology and molecular genetics of primary hyperoxaluria type 1. Prospects for gene therapy. Neprol Dial Trasplant 1995;10(Suppl 8):24."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hoppe B, Leumann E. Diagnostic and therapeutic strategies in hyperoxaluria: a plea for early intervention. Neprol Dial Trasplant 2004;19:39."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hoppe B, Kemper MJ, et al. \u{A0}et all. Plasmacalcium-oxalate saturation in children with renal insufficiency and in children with primary hyperoxaluria. Kidney Intern 1998;54:921."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Lorenzo V, Torres A, Hernandez D, et al. Evolución de la enfermedad ósea en pacientes con hiperoxaluria primaria en hemodiálisis. Nefrologia 1990;10(1):53."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Lorenzo V, Álvarez, A, Torres A, et al. Presentation\u{A0} and role of trasplantation in adult patients with type 1 primary hyperoxaluria and the I244T AGXT mutation: Single-center experience. Kidney Int 2006;1115-9."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Lorenzo V, Hernández D, Domínguez M, et al. Oxalosis as a cause of\u{A0} absolute resistance to EPO in chronic hemodialysis patients. Neprol Dial Trasplant 1992;7:1163-4."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003100000002/v0_201502091641/X2013251411051547/v0_201502091641/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35437"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Letters to the Editor - Brief Case Reports"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003100000002/v0_201502091641/X2013251411051547/v0_201502091641/en/P1-E518-S2912-A10725-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411051547?idApp=UINPBA000064"
]