When the Cause Is Not Crystal Clear

A 55 year old woman with chronic renal insufficiency presented with recurrent falls, dizziness, and lethargy. Initial evaluation revealed acute on chronic kidney injury, hypotension, and hyperkalemia. Despite fluid resuscitation, her condition worsened, prompting further investigation. Renal biopsy identified oxalate crystals, leading to a diagnosis of secondary hyperoxaluria likely caused by orlistat, a weight loss medication. The patient’s renal function did not fully recover, and she required peritoneal dialysis. This case highlights the importance of considering medication-induced nephrotoxicity in unexplained renal failure, particularly in patients with preexisting kidney disease.

A 55 year old woman with chronic renal insufficiency presented with recurrent falls, dizziness, and lethargy. Initial evaluation revealed acute on chronic kidney injury, hypotension, and hyperkalemia. Despite fluid resuscitation, her condition worsened, prompting further investigation. Renal biopsy identified oxalate crystals, leading to a diagnosis of secondary hyperoxaluria likely caused by orlistat, a weight loss medication. The patient’s renal function did not fully recover, and she required peritoneal dialysis. This case highlights the importance of considering medication-induced nephrotoxicity in unexplained renal failure, particularly in patients with preexisting kidney disease.