Exocrine pancreatic insufficiency (EPI) is the inability of the pancreas to produce essential digestive enzymes for fat metabolism, leading to systemic and nutritional repercussions. Although its manifestations are typically digestive, systemic complications such as enteric hyperoxaluria can occur. We present a 68-year-old man with insulin-dependent diabetes mellitus, who developed steatorrheic diarrhea and significant weight loss. Computed tomography revealed an atrophic pancreas with diffuse calcifications. Based on a diagnosis of chronic pancreatitis, pancreatic enzyme replacement therapy (PERT) was initiated empirically with clinical improvement. Three years later, while asymptomatic from a gastrointestinal perspective, he developed bilateral calcium oxalate nephrolithiasis progressing to end-stage renal disease, requiring hemodialysis. This was interpreted as oxalate nephropathy sec...