Primary Hyperoxaluria Type 1 (PH1) - Urinary System Animation
Primary Hyperoxaluria Type 1 (PH1) - Urinary System Animation

The clinical manifestations of PH1

Primary hyperoxaluria type 1 (PH1) has heterogeneous clinical manifestations.1 However, diagnosing PH1 can be straightforward if you know what to look for.2,3

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Look closely, as disease presentation varies widely1,4

PH1 is a heterogeneous disease.1,5 At any age, patients may present with one or more of the clinical manifestations below.1,6

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Pediatric Kidney Stone - Icon

Kidney stone in a child1

Kidney Stone - Icon

Recurrent urolithiasis5

Pediatric PH1 Medical Management - Parents With Child - Icon

Family history of stones3

Damaged Kidneys - Icon


Kidneys - Icon

Progressive kidney function decline of unknown cause that commonly progresses to end-stage renal disease (ESRD)3,5,7

Failure To Thrive in Infancy - Icon

Failure to thrive in infancy1

Though kidney stones are the most common clinical manifestation, there may be PH1 patients who are not stone formers.1.7

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PH1 is often overlooked6,8,9

Historically, PH1 has been underdiagnosed. This may be due to several factors, including a low index of suspicion and symptomatology that is nonspecific or shared with other diseases.6,8-10

Variable rates of disease progression among PH1 patients and delays in diagnosis contribute to the burden of the disease.6,11

Clinical manifestations may not be recognized.6 Additionally, they may not be considered as indicative of PH1, delaying diagnosis until end-stage renal disease (ESRD).4,8,12-14 At that point, patients have irreparable kidney damage. 4,8,12-14

PH1 by the numbers

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% 50

of PH1 patients may be undiagnosed, although data on prevalence are limited10


is the median delay in adults between onset of clinical manifestations and diagnosis15

of diagnoses in adults occur after progression to ESRD4,8,12-14

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Kidney stones may be a sign of something more serious16

Recurrent kidney stones in an adult or any kidney stone in a child or adolescent could be a sign of PH1.16,17
Refer these patients for a full work-up and confirm PH1 with genetic testing.16

Test for PH1

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Regardless of renal status, acute decline can occur suddenly18,19

Though the course of PH1 is well characterized, with patients typically advancing toward ESRD, the rate of progression is variable.1,6,11 In some instances, renal function can decline after a single incident of dehydration due to acute illness or intense physical activity.18-22 This can occur even in patients with previously stable disease.20

PH1 can be fatal, often due to complications of ESRD and/or systemic oxalosis1,6

Once the estimated glomerular filtration rate declines to below 30-45 mL/min/1.73 m2, systemic oxalosis can occur because the kidney is unable to excrete oxalate effectively due to toxicity from calcium oxalate crystal deposition.6,7

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Diagnose as soon as possible; prompt management may mitigate damage.1-4,7,25

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Watch the Skinner family discuss their daughter Claire’s diagnosis

Parent of Child With Primary Hyperoxaluria Type 1 (PH1) - PH1 Diagnosis - Video Thumbnail

When their daughter Claire was born, everything seemed normal. Claire’s diagnosis of PH1 came as a shock, and both the Skinners and their physicians were faced with the challenge of learning about and managing her rare disease.

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Child With Primary Hyperoxaluria Type 1 (PH1) and Parent

"On the outside, everybody looks normal. They act normal…but everything with PH1 is really internal, and it's what's going on inside, which most people don't know, and most people don't recognize."

Jared Skinner

Father of Claire, Benson, and Lucy Skinner

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