Progressive polyradiculoneuropathy due to intraneural oxalate deposition in type 1 primary hyperoxaluria

Sarah E. Berini, Jennifer A. Tracy, Janean K. Engelstad, Elizabeth C. Lorenz, Dawn S. Milliner, Peter J. Dyck

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Introduction: A 24-year-old man with primary hyperoxaluria type 1 (PH1) presented with a rapidly progressive axonal and demyelinating sensorimotor polyradiculoneuropathy shortly after the onset of end-stage renal disease. His plasma oxalate level was markedly elevated at 107 μmol/L (normal <1.8 μmol/L). Methods: A sural nerve biopsy was performed. Teased fiber and paraffin and epoxy sections were done and morphometric procedures were performed on this sample and on an archived sample from a 22-year-old man as an age- and gender-matched control. Embedded teased fiber electron microscopy was also performed. Results: The biopsy revealed secondary demyelination and axonal degeneration. Under polarized light, multiple bright hexagonal, rectangular, and starburst inclusions, typical of calcium oxalate monohydrate crystals, were seen. Conclusions: The proposed mechanisms of nerve damage include disruption of axonal transport due to crystal deposition, toxic effect of oxalate, or nerve ischemia related to vessel occlusion from oxalate crystal deposition.

Original languageEnglish (US)
Pages (from-to)449-454
Number of pages6
JournalMuscle and Nerve
Issue number3
StatePublished - Mar 1 2015


  • Crystalline neuropathy
  • Nerve pathology
  • Peripheral neuropathy
  • Primary hyperoxaluria type 1
  • Renal failure

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Cellular and Molecular Neuroscience
  • Physiology (medical)


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