Oxalate nephropathy is a major cause of kidney injury in surgically treated pancreatic adenocarcinoma patients

Geoffroy Desbuissons; Hassan Izzedine; Armelle Bardier; Olivier Dubreuil; Jean Christophe Vaillant; Vincent Frochot; Lucile Mercadal

doi:10.1093/ckj/sfz015

Oxalate nephropathy is a major cause of kidney injury in surgically treated pancreatic adenocarcinoma patients

Clin Kidney J. 2019 Feb 18;12(6):821-828. doi: 10.1093/ckj/sfz015. eCollection 2019 Dec.

Authors

Geoffroy Desbuissons^{1

2}, Hassan Izzedine^{1

3}, Armelle Bardier⁴, Olivier Dubreuil⁵, Jean Christophe Vaillant⁶, Vincent Frochot⁷, Lucile Mercadal¹

Affiliations

¹ Nephrology Department, Pitié-Salpêtrière University Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France.
² Division of Nephrology, RAMSAY-Générale de Santé, Hôpital privé de l'Ouest Parisien, Trappes, France.
³ Division of Oncology, RAMSAY-Générale de Santé, Hôpital Privé Les Peupliers, Paris, France.
⁴ Pathology Department, Pitié-Salpêtrière University Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France.
⁵ Oncology Department, Pitié-Salpêtrière University Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France.
⁶ Department of Hepato Pancreato Biliary Surgery, Pitié-Salpêtrière University Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France.
⁷ Physiology Unit, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France.

Abstract

Background: Despite new therapeutics, the prognosis for pancreatic cancer remains poor. Pancreatic surgery is a therapeutic option in non-metastatic forms. The consequences for renal function are poorly described.

Methods: Patients who underwent surgery for pancreatic cancer between 1 January 2010 and 1 January 2017 and who experienced kidney biopsy in the Pitié-Salpêtrière Hospital were analysed.

Results: Two hundred and ninety-four patients had pancreatic surgery during the period of analysis and five of them had a kidney biopsy (mean ± SD 20 months ±13.6 months after surgery) during the post-operative follow-up. Among these patients, three exhibited oxalate nephropathy (ON), indicating that the prevalence of ON in patients with pancreatectomy is at least 1%. ON may be insidious, with chronic renal failure without urinary abnormalities. All patients had a high oxalate-to-creatinine ratio in urine sample. Renal function improved after specific management of ON in two patients. Pancreaticoduodenectomy may represent a higher risk of ON than left pancreatectomy.

Conclusion: Although rare and underestimated, ON appears to be a real risk after pancreatic resection. Early detection may preserve renal function.

Keywords: chronic kidney disease; oxalate nephropathy; pancreatectomy; pancreatic adenocarcinoma; pancreatic exocrine insufficiency.