What is your approach for patients with recurrent nephrolithiasis who you have a strong suspicion for primary hyperoxaluria though genetic testing returns without any abnormalities?

As an adult nephrologist, most of my patients with oxalosis have enteric hyperoxaluria. I suggest you take a careful history, looking for inflammatory bowel disease, removal of small bowel or surgical rerouting of the intestines.

If your patient is a child, I would explore the possibility of insurance coverage for the new treatments for genetic hyperoxaluria. In this situation, I would not advise liver-kidney transplantation.

Stephen B. Erickson, MD