• Mohamed W Abukhatwah, Samia H Almalki, Mohammed S Althobaiti, Abdulla O Alharbi, Najla K Almalki, and Naglaa M Kamal.
• Pediatric department, Alhada Armed Forces Hospital.
• Medicine (Baltimore). 2020 Jun 19; 99 (25): e20371.

IntroductionPrimary hyperoxaluria type 1 (PH1) is a genetic autosomal recessively inherited disorder due to mutation in the alanine-glyoxylate aminotransferase (AGXT) gene. It usually presents in children with nephrolithiasis and/or nephrocalcinosis and progressive renal function impairment and end stage renal disease (ESRD).Patient ConcernsA 13 years old Saudi boy with history of recurrent urolithiasis since the age of 2 years presented to us with picture of ESRD. He has strong family history of urolithiasis.DiagnosisWorking up the patient suggested the diagnosis of PH1 based on the typical clinical, laboratory, and imaging findings which was genetically proved by positive AXGT gene mutation. The mutation detected was not previously reported in literature. The mutation detected was not previously reported in literature. The novel mutation c. 799A>T p. (IIe267Phe) detected in our patient extend the spectrum of the known AGXT gene mutations.Interventions And OutcomesHemodialysis as a temporary step followed by renal transplantation which is the only cure.ConclusionHigh index of suspicion of PH1 before ESRD should be considered in any patient who has recurrent urolithiasis since early life especially in presence of strong family history.

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