Primary hyperoxaluria (PH) causes end-stage renal disease (ESRD). Missed diagnosis or relapse in transplanted kidney is common. We present a 36-year-old man with a history of recurrent renal calculus which progressed to end-stage renal disease. He underwent kidney-transplant surgery. Renal function tests worsened progressively in the first-week post-transplant. Transplanted kidney biopsy demonstrated the underlying PH. His several hospital admissions and complications made us to report this case and suggest re-evaluation of PH before kidney transplant in ESRD.

Keywords: End-stage renal disease (ESRD), Primary hyperoxaluria (PH), Kidney transplant

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