Authors
Hiroki Ito, Takuo Hirose, Yuya Suzuki, Kentaro Yano, Risa Ishikawa, Tsubasa Yuki, Hideaki Hashimoto, Go Anan, Takashi Shimada, Hideya Itagaki, Yoshinobu Abe, Tomoyuki Endo, Takefumi Mori
Published in
CEN case reports. Volume 15. Issue 5. Aug 13, 2026. Epub Aug 13, 2026.
Abstract
Ethylene glycol (EG) poisoning typically causes severe metabolic acidosis and acute kidney injury (AKI), characterized by urinary calcium oxalate (CaOx) crystals. Although needle-shaped calcium oxalate monohydrate (COM) crystals are a recognized diagnostic marker in the acute phase, sequential changes in urinary crystal morphology during recovery have not been well characterized in human cases. We present a 32-year-old man who developed profound metabolic acidosis (pH 6.747) and AKI (serum creatinine 1.56 mg/dL) after ingesting a lethal dose of EG. Following emergency hemodialysis and fomepizole treatment, urinalysis showed a sequential transition of urinary CaOx crystals from abundant needle-shaped COM in the acute phase to dumbbell-shaped COM and octahedral calcium oxalate dihydrate (COD) by day 14. This transition was observed during recovery, and renal function fully recovered by day 68 (serum creatinine 0.78 mg/dL). Low-vacuum scanning electron microscopy (LV-SEM) provided detailed three-dimensional visualization of these recovery-phase crystals after simple cytospin preparation, without chemical fixation or conductive coating. This report provides the first human LV-SEM visualization and characterization of recovery-phase urinary calcium oxalate crystals in ethylene glycol poisoning. These morphological changes may reflect recovery-related changes in the intratubular environment and offer pathophysiological insight into the transition from the acute toxic phase to recovery.
PMID:
42593571
Bibliographic data and abstract were imported from PubMed on 13 Aug 2026.
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