Chronic Yellow Rice Wine Consumption Tied to Acute Kidney Injury: Case Report Reveals Rare Cause of Oxalate Nephropathy

The patient presented to the hospital with complaints of diarrhea and newly detected elevated serum creatinine. He reported no prior history of kidney disease, and his physical examination was largely unremarkable apart from a high blood pressure reading of 174/79 mmHg. Initial investigations revealed significant renal dysfunction, with serum creatinine at 407 µmol/L and an estimated glomerular filtration rate (eGFR) of just 13.77 mL/min/1.73 m². Urinalysis showed mild proteinuria, and tests for autoimmune disorders, infections, and heavy metal exposure returned negative results.

A renal biopsy was performed to determine the underlying cause. Histological evaluation revealed features of acute tubular injury, including brush border detachment, tubular dilation, necrosis, and vacuolar degeneration. Several birefringent crystals consistent with calcium oxalate were observed under polarized light. This finding pointed toward a diagnosis of acute oxalate nephropathy, confirmed by elevated 24-hour urinary oxalate levels (283.93 mg/1.73 m²/24 h). Genetic testing ruled out primary hyperoxaluria, suggesting the condition was secondary to dietary intake.

The patient was managed with hydration, potassium citrate, vitamin B6, and probiotics, along with strict avoidance of alcohol, mainly yellow rice wine. Over two months, his renal function improved significantly. Follow-up tests showed reduced urinary oxalate levels to 56.38 mg/1.73 m²/24 h and normalized serum creatinine levels. Proteinuria also declined, indicating recovery.

Oxalate nephropathy is a rare condition in which calcium oxalate crystals accumulate in the kidneys, leading to inflammation, tubular damage, and progressive loss of function. While secondary oxalate nephropathy has been previously linked to high vitamin C intake and certain foods like peanuts and purslane, this is one of the first documented cases implicating yellow rice wine.

"The case emphasizes the diagnostic value of renal biopsy in unexplained AKI and highlights the need to consider dietary sources of oxalate. Clinicians are advised to take comprehensive dietary histories and consider oxalate nephropathy as a differential in similar presentations. Early diagnosis and removal of the offending agent are crucial to reversing renal damage and preventing long-term complications," Rong Zhou, Department of Nephrology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China, and colleagues concluded.

Reference:

Chen, X., Shen, J., Liu, Y. et al. Acute oxalate nephropathy due to yellow rice wine: a case report. BMC Nephrol 26, 151 (2025). https://doi.org/10.1186/s12882-025-04067-6