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王 昱, 张 慧, 邓 雪, 刘 伟, 陈 璐, 赵 宁, 张 晓, 宋 志, 耿 研, 季 兰, 王 玉, 张 卓. [Diagnostic values of urinary citrate for kidney stones in patients with primary gout]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2022; 54:1134-1140. [PMID: 36533345 PMCID: PMC9761807 DOI: 10.19723/j.issn.1671-167x.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To evaluate the relationship between 24 h urinary ion content and kidney stones, and to explore the diagnostic values of kidney stone in primary gout patients. METHODS Patients diagnosed with primary gout had ultrasound scanning of both feet and kidneys in Peking University First Hospital from Jan. 2020 to May 2021. Their clinical characteristics were compared between the positive and negative kidney stone groups, and the relationship between kidney stone and urinary ion composition were analyzed. Risk factors of kidney stone were analyzed. The explored diagnostic values were evaluated for urinary oxalate and citrate according with uric acid kidney stones by dual-energy computed tomography (DECT). RESULTS Among the 100 gouty patients, 80 patients had uric acid crystal deposition in lower joints of extremity by ultrasonography, 61 patients had kidney stone, and 34 had kidney uric acid stones by DECT. All the multiple kidney stones were proved as uric acid kidney stones by DECT. Compared with patients without kidney stone group proved by ultrasonography, patients with kidney stone had longer gouty duration [(48.7±26.6) months vs. (84.0±30.6) months, P=0.01], higher 24 h urinary oxalate [(20.1±9.6) mg vs. (28.6±20.7) mg, P=0.001] and lower 24 h urinary citrate [(506.3±315.4) mg vs. (355.7±219.6) mg, P=0.001]. Compared with the patients without kidney stone by DECT, the patients with uric acid kidney stone also had longer disease duration [(49.1±28.4) months vs. (108.3±72.2) months, P=0.001], higher 24 h urinary oxalate [(23.6±16.9) mg vs. (28.5±18.8) mg, P < 0.05], lower 24 h urinary citrate [(556.0±316.3) mg vs. (391.7±261.2) mg, P < 0.05], higher serum uric acid [(466.2±134.5) μmol/L vs. (517.2±18.1) μmol/L, P < 0.05] and higher 24 h urinary uric acid [(1 518.1±893.4) mg vs. (1 684.2±812.1) mg, P < 0.05]. Logistic regression analysis showed long gout disease duration (OR=1.229, 95%CI: 1.062-1.522, P < 0.05), high serum uric acid level (OR=1.137, 95%CI: 1.001-1.213, P=0.01), low 24 h urinary citrate (OR=0.821, 95%CI: 0.659-0.952, P=0.01) were all risk factors of kidney stones by ultrasonography. Also, long gout disease duration (OR=1.201, 95%CI: 1.101-1.437, P=0.005), high serum creatine uric level (OR=1.145, 95%CI: 1.001-1.182, P=0.04), low 24 h urinary citrate (OR=0.837, 95%CI: 0.739-0.931, P=0.02) were all risk factors of kidney uric acid stones by DECT. CONCLUSION Long disease duration and low 24 h urinary citrate were risk factors for kidney stones.
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Affiliation(s)
- 昱 王
- 北京大学第一医院风湿免疫科,北京 100034Department of Rheumatology and Immunology, Peking University First Hospital, Beijing 100034, China
| | - 慧敏 张
- 北京大学第一医院肾内科,北京 100034Department of Nephrology, Peking University First Hospital, Beijing 100034, China
| | - 雪蓉 邓
- 北京大学第一医院风湿免疫科,北京 100034Department of Rheumatology and Immunology, Peking University First Hospital, Beijing 100034, China
| | - 伟伟 刘
- 河北省沧州市渤海新区中捷医院综合内科,河北沧州 061108Department of Internal General Medicine, Zhongjie Hospital, Cangzhou 061108, Hebei, China
| | - 璐 陈
- 北京航空总医院中医科,北京 100012Department of Traditional Chinese Medicine, Aviation General Hospital of China Medical University, Beijing 100012, China
| | - 宁 赵
- 北京中医药大学附属护国寺中医医院针灸科,北京 100035Department of Acupuncture, Huguosi Traditional Chinese Medicine Hospital affiliated to Beijing University of Chinese Medicine, Beijing 100035, China
| | - 晓慧 张
- 北京大学第一医院风湿免疫科,北京 100034Department of Rheumatology and Immunology, Peking University First Hospital, Beijing 100034, China
| | - 志博 宋
- 北京大学第一医院风湿免疫科,北京 100034Department of Rheumatology and Immunology, Peking University First Hospital, Beijing 100034, China
| | - 研 耿
- 北京大学第一医院风湿免疫科,北京 100034Department of Rheumatology and Immunology, Peking University First Hospital, Beijing 100034, China
| | - 兰岚 季
- 北京大学第一医院风湿免疫科,北京 100034Department of Rheumatology and Immunology, Peking University First Hospital, Beijing 100034, China
| | - 玉 王
- 北京大学第一医院肾内科,北京 100034Department of Nephrology, Peking University First Hospital, Beijing 100034, China
| | - 卓莉 张
- 北京大学第一医院风湿免疫科,北京 100034Department of Rheumatology and Immunology, Peking University First Hospital, Beijing 100034, China
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Chewcharat A, Thongprayoon C, Vaughan LE, Mehta RA, Schulte PJ, O'Connor HM, Lieske JC, Taylor EN, Rule AD. Dietary Risk Factors for Incident and Recurrent Symptomatic Kidney Stones. Mayo Clin Proc 2022; 97:1437-1448. [PMID: 35933132 DOI: 10.1016/j.mayocp.2022.04.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/01/2022] [Accepted: 04/26/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare dietary factors between incident symptomatic stone formers and controls, and among the incident stone formers, to determine whether dietary factors were predictive of symptomatic recurrence. PATIENTS AND METHODS We prospectively recruited 411 local incident symptomatic kidney stone formers (medical record validated) and 384 controls who were seen at Mayo Clinic in Minnesota or Florida between January 1, 2009, and August 31, 2018. Dietary factors were based on a Viocare, Inc, food frequency questionnaire administered during a baseline in-person study visit. Logistic regression compared dietary risk factors between incident symptomatic stone formers and controls. Incident stone formers were followed up for validated symptomatic recurrence in the medical record. Cox proportional hazards models estimated risk of symptomatic recurrence with dietary factors. Analyses adjusted for fluid intake, energy intake, and nondietary risk factors. RESULTS In fully adjusted analyses, lower dietary calcium, potassium, caffeine, phytate, and fluid intake were all associated with a higher odds of an incident symptomatic kidney stone. Among incident stone formers, 73 experienced symptomatic recurrence during a median 4.1 years of follow-up. Adjusting for body mass index, fluid intake, and energy intake, lower dietary calcium and lower potassium intake were predictive of symptomatic kidney stone recurrence. With further adjustment for nondietary risk factors, lower dietary calcium intake remained a predictor of recurrence, but lower potassium intake only remained a predictor of recurrence among those not taking thiazide diuretics or calcium supplements. CONCLUSION Enriching diets in stone formers with foods high in calcium and potassium may help prevent recurrent symptomatic kidney stones.
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Affiliation(s)
- Api Chewcharat
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | | | - Lisa E Vaughan
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | - Ramila A Mehta
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | - Phillip J Schulte
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | - Helen M O'Connor
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN
| | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Eric N Taylor
- Division of Nephrology, VA Maine Healthcare System, Augusta, ME
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
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Tsai JL, Tsai SF. Calcium oxalate crystal related kidney injury in a patient receiving Roux-en Y hepaticojejunostomy due to gall bladder cancer. BMC Nephrol 2017; 18:106. [PMID: 28356078 PMCID: PMC5372328 DOI: 10.1186/s12882-017-0520-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 03/22/2017] [Indexed: 11/24/2022] Open
Abstract
Background Calcium oxalate nephropathy is rare in current practice. It was a common complication during jejunoileal bypass, but much less seen in modern gastric bypass surgery for morbid obesity. The major cause of it is enteric hyperoxaluria. Case presentation We report on a patient here with acute kidney disease due to calcium oxalate nephropathy, rather than the conditions mentioned above. The male patient received a Roux-en Y hepaticojejunostomy and common bile duct drainage. In addition to enteric hyperoxaluria, chronic kidney disease related metabolic acidosis, chronic diarrhea related volume depletion, a high oxalate and low potassium diet, long term ascorbic acid intake and long term exposure to antibiotics, all predisposed him to having oxalate nephropathy. Conclusion This is the first case with such conditions and we recommend that similarly diagnosed patients avoid all these predisposing factors, in order to avoid this rare disease and its undesired outcome.
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Affiliation(s)
- Jun-Li Tsai
- Department of Family Medicine, Cheng Ching General Hospital, Taichung, Taiwan
| | - Shang-Feng Tsai
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, Taiwan, 40705, Taiwan, Republic of China. .,Department of Life Science, Tunghai University, Taichung, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Shen AL, Lin HL, Tseng YF, Lin HC, Hsu CY, Chou CY. Topiramate may not increase risk of urolithiasis: A nationwide population-based cohort study. Seizure 2015; 29:86-9. [DOI: 10.1016/j.seizure.2015.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 02/04/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022] Open
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Panhwar AH, Kazi TG, Afridi HI, Shaikh HR, Arain SA, Arain SS, Brahman KD. Evaluation of calcium and magnesium in scalp hair samples of population consuming different drinking water: risk of kidney stone. Biol Trace Elem Res 2013; 156:67-73. [PMID: 24218227 DOI: 10.1007/s12011-013-9850-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 10/21/2013] [Indexed: 11/25/2022]
Abstract
The objective of this study was to examine the relationship between calcium (Ca) and magnesium (Mg) in underground water (UGW), bottled mineral water (BMW), and domestic treated water (DTW) with related to risk of kidney stones. The water samples were collected from different areas of Sindh, Pakistan. The scalp hair samples of both genders, age ranged 30-60 years, consuming different types of water, have or have not kidney disorders, were selected. The Ca and Mg concentrations were determined in scalp hair of study subjects and water by flame atomic absorption spectroscopy. The Ca and Mg contents in different types of drinking water, UGW, DTW, and BMW, were found in the range of 79.1-466, 23.7-140, and 45-270 mg/L and 4.43-125, 5.23-39.6, and 7.16-51.3 mg/L, respectively. It was observed that Ca concentration in the scalp hair samples of kidney stone patients consuming different types of drinking water was found to be higher (2,895-4721 μg/g) while Mg level (84.3-101 μg/g) was lower as compare to referents subjects (2,490-2,730 μg/g for Ca, 107-128 μg/g for Mg) in both genders. The positive correlation was found between Ca and Mg levels in water with related to kidney stone formations in population, especially who consumed underground water. A relative risk and odd ratio were calculated; the relative risk had a strong positive association with incidence of kidney stone which depends on types of drinking water.
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Affiliation(s)
- Abdul Haleem Panhwar
- National Centre of Excellence in Analytical Chemistry, University of Sindh, Jamshoro, Pakistan, 76080,
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Kanlaya R, Fong-ngern K, Thongboonkerd V. Cellular adaptive response of distal renal tubular cells to high-oxalate environment highlights surface alpha-enolase as the enhancer of calcium oxalate monohydrate crystal adhesion. J Proteomics 2013; 80:55-65. [DOI: 10.1016/j.jprot.2013.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 12/07/2012] [Accepted: 01/07/2013] [Indexed: 01/14/2023]
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Mirzazadeh M, Nouran MG, Richards KA, Zare M. Effects of drinking water quality on urinary parameters in men with and without urinary tract stones. Urology 2011; 79:501-7. [PMID: 22173182 DOI: 10.1016/j.urology.2011.10.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 08/17/2011] [Accepted: 10/14/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE There is some controversy regarding the impact of water hardness on stone risk. Our study addresses this issue in a controlled setting. MATERIAL AND METHODS Fifteen stone-former (SF) and 14 non-stone-former (NSF) males participated in this study in 3 intervals of 2 days each. Subjects collected a 24-hour urine sample while consuming a self-selected diet. They were then administered controlled diets. During the first 2 days, patients consumed water of minimal hardness (WMH), followed by tap water (TW) with moderate hardness on days 3 and 4, and mineral water (MW) on the final 2 days. Calcium (Ca), phosphorus, uric acid, oxalate, citrate, magnesium (Mg), sodium, potassium, and creatinine (Cr) content were measured in 24-hour urine samples on days 2, 4, and 6. RESULTS Differences in water hardness and analytes were statistically significant among the different water types (P < .05). Urinary output in both groups increased during intervention with all 3 varieties of water (P < .05). Specific gravity of urine decreased in both groups drinking WMH and TW (P < .05) but not with MW. Mg/g Cr level was higher in NSF at baseline (P < .01), WMH (P < .05), and TW (P < .05). With the increase in drinking water hardness, Ca/g Cr ratio increased in SF but not in NSF (P < .05). CONCLUSIONS NSF had significantly higher urinary Mg/g Cr excretion rate before intervention than SF (P < .01). Increasing drinking water hardness while controlling for all other factors increased Ca/g Cr ratio in SF, rendering them at least theoretically more inclined to stone formation.
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Affiliation(s)
- Majid Mirzazadeh
- Wake Forest University Baptist Medical Center, Department of Urology, Medical Center Boulevard, Winston-Salem, NC 27157, USA
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Mahajan P, Weber-Shrikant E, Iyer R, Sitrin M, Lohr J, Arora P. CKD in a Patient With Pancreatic Carcinoma. Am J Kidney Dis 2010; 56:591-4. [DOI: 10.1053/j.ajkd.2009.10.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 10/30/2009] [Indexed: 01/11/2023]
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Diet, but not oral probiotics, effectively reduces urinary oxalate excretion and calcium oxalate supersaturation. Kidney Int 2010; 78:1178-85. [PMID: 20736987 DOI: 10.1038/ki.2010.310] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We examined the effect of a controlled diet and two probiotic preparations on urinary oxalate excretion, a risk factor for calcium oxalate kidney stone formation, in patients with mild hyperoxaluria. Patients were randomized to a placebo, a probiotic, or a synbiotic preparation. This tested whether these probiotic preparations can increase oxalate metabolism in the intestine and/or decrease oxalate absorption from the gut. Patients were maintained on a controlled diet to remove the confounding variable of differing oxalate intake from food. Urinary oxalate excretion and calcium oxalate supersaturation on the controlled diet were significantly lower compared with baseline on a free-choice diet. Neither study preparation reduced urinary oxalate excretion nor calcium oxalate supersaturation. Fecal lactobacilli colony counts increased on both preparations, whereas enterococcal and yeast colony counts were increased on the synbiotic. Total urine volume and the excretion of oxalate and calcium were all strong independent determinants of urinary calcium oxalate supersaturation. Hence, dietary oxalate restriction reduced urinary oxalate excretion, but the tested probiotics did not influence urinary oxalate levels in patients on a restricted oxalate diet. However, this study suggests that dietary oxalate restriction is useful for kidney stone prevention.
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Plasma oxalate level in pediatric calcium stone formers with or without secondary hyperoxaluria. ACTA ACUST UNITED AC 2009; 37:101-5. [DOI: 10.1007/s00240-009-0179-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2008] [Accepted: 01/12/2009] [Indexed: 10/21/2022]
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Sikora P, von Unruh GE, Beck B, Feldkötter M, Zajaczkowska M, Hesse A, Hoppe B. [13C2]oxalate absorption in children with idiopathic calcium oxalate urolithiasis or primary hyperoxaluria. Kidney Int 2008; 73:1181-6. [PMID: 18337715 DOI: 10.1038/ki.2008.63] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Intestinal oxalate absorption is an important part of oxalate metabolism influencing its urinary excretion and its measurement can be a valuable diagnostic tool in hyperoxaluric disorders. In this study, we use [(13)C(2)]oxalate absorption under standardized dietary conditions to assess intestinal oxalate absorption and its impact on urinary oxalate excretion. Tests were conducted in age-matched pediatric patients that included 60 with idiopathic calcium oxalate urolithiasis, 13 with primary hyperoxaluria, and 35 healthy children. In the idiopathic stone formers, median oxalate absorption was significantly higher than that in the controls or in patients with primary disease. From standardized values obtained in control patients, oxalate hyperabsorption was detected in 23 patients with idiopathic disease but not in any patients with primary hyperoxaluria; therefore, a significant correlation between intestinal absorption and urinary excretion was found only in those with the idiopathic disease. We have shown that increased intestinal oxalate absorption is an important risk factor of idiopathic calcium oxalate urolithiasis. In contrast, low intestinal oxalate absorption in patients with primary hyperoxaluria indicates that only foods with excessive oxalate content be restricted from their diet.
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Affiliation(s)
- P Sikora
- Department of Pediatric Nephrology, Lublin Medical University, Lublin, Poland
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Abstract
Nephrolithiasis is responsible for 1 in 1000 to 1 in 7600 pediatric hospital admissions annually throughout the United States. Seventy-five percent of children with nephrolithiasis have an identifiable predisposition to stone formation. This article reviews the different causes and disease states associated with nephrolithiasis in the pediatric population. The initial evaluation and the metabolic evaluation of children with nephrolithiasis are reviewed. Treatment modalities for the different stone types are also described.
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Affiliation(s)
- Julie A Nicoletta
- Division of Pediatric Nephrology, Department of Pediatrics, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14624, USA.
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Greene EL, Farell G, Yu S, Matthews T, Kumar V, Lieske JC. Renal cell adaptation to oxalate. ACTA ACUST UNITED AC 2005; 33:340-8. [PMID: 16284879 DOI: 10.1007/s00240-005-0491-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2005] [Accepted: 06/08/2005] [Indexed: 10/25/2022]
Abstract
Renal manifestations of chronic hyperoxaluria include nephrolithiasis and, when extreme, interstitial scarring and progressive loss of function. Exposure of cultured renal cells to oxalate has been reported to cause cell death, as well as proliferation. The current study was performed to assess the time course and cell-type specificity of these responses. Proximal (LLC-PK(1)) and distal [cIMCD and primary human renal (HRC1)] renal epithelial cells, as well as interstitial KNRK cells, were exposed to oxalate (0.5-2.0 mM) for 24-72 h. The generation of reactive oxygen species (ROS) was measured using the fluorescent probe DCF, and cell number was determined with CyQuant reagent. HSP-70 expression was assessed via real time PCR and quantitative Western blot. In response to all oxalate concentrations (0.5-2.0 mM) and lengths of exposure (15 min-2 h), cultured proximal and distal renal epithelial cells and renal fibroblasts generated ROS. After 24 h, cells demonstrated initial cell death and decrease in cell numbers, but by 48-72 h adapted and grew, despite the continued presence of oxalate. This response was associated with increased expression of HSP-70 mRNA and protein. Renal cells in vivo may possess adaptive mechanisms to withstand chronic hyperoxaluria, including increased expression of chaperone molecules such as HSP-70.
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Affiliation(s)
- Eddie L Greene
- Division of Nephrology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
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Krishnamurthy MS, Hruska KA, Chandhoke PS. The urinary response to an oral oxalate load in recurrent calcium stone formers. J Urol 2003; 169:2030-3. [PMID: 12771711 DOI: 10.1097/01.ju.0000062527.37579.49] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Dietary oxalate may contribute up to 50% to 80% of the oxalate excreted in urine. We studied the urinary response to an oral oxalate load in male and female idiopathic recurrent calcium oxalate stone formers with and without mild hyperoxaluria to evaluate the potential pathophysiological significance of dietary oxalate. MATERIALS AND METHODS A total of 60 recurrent calcium stone formers underwent an oral oxalate load test. Urine samples were obtained after an overnight fast. Each patient then received an oral oxalate load (5 mM. sodium oxalate dissolved in 250 ml. distilled water) and 3, 2-hour urine samples were obtained 2, 4 and 6 hours after the oxalate load. We compared the response to the oxalate load in patients with and without mild hyperoxaluria, and in male and female patients without hyperoxaluria. RESULTS The peak urinary response occurred 4 hours after the oral oxalate load in all patients. Those with mild hyperoxaluria had a mean fasting urinary oxalate-to-creatinine ratio +/- SE of 0.027 +/- 0.003 and a mean peak urinary oxalate-to-creatinine ratio of 0.071 +/- 0.006. In comparison, patients with normal oxalate excretion had a fasting and peak urinary oxalate-to-creatinine ratio of 0.018 +/- 0.001 and 0.056 +/- 0.004, respectively (p <0.05). The mean 6-hour increment for urinary oxalate excretion after the oxalate load for patients with hyperoxaluria versus those with normal urinary oxalate excretion was 17.2 +/- 1.9 versus 12.1 +/- 0.98 mg. (p <0.05). In the subset of patients with normal urinary oxalate excretion mean 6-hour cumulative urinary oxalate excretion was 16.8 +/- 1.3 and 13.3 +/- 1.4 mg. in males and females, respectively (p not significant). CONCLUSIONS Recurrent calcium stone formers with mild hyperoxaluria have higher fasting urinary oxalate and an exaggerated urinary response to an oral oxalate load compared with recurrent calcium stone formers with normal urinary oxalate excretion. Men and women stone formers without hyperoxaluria excrete similar fractions of an oral oxalate load. Increased gastrointestinal absorption and renal excretion of dietary oxalate may be a significant pathophysiological mechanism of stone formation in patients with mild hyperoxaluria.
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Affiliation(s)
- Mina S Krishnamurthy
- Department of Surgery (Urology), University of Colorado Health Sciences Center, Denver, Colorado, USA
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Campieri C, Campieri M, Bertuzzi V, Swennen E, Matteuzzi D, Stefoni S, Pirovano F, Centi C, Ulisse S, Famularo G, De Simone C. Reduction of oxaluria after an oral course of lactic acid bacteria at high concentration. Kidney Int 2001; 60:1097-105. [PMID: 11532105 DOI: 10.1046/j.1523-1755.2001.0600031097.x] [Citation(s) in RCA: 185] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Hyperoxaluria is a major risk factor for renal stones, and in most cases, it appears to be sustained by increased dietary load or increased intestinal absorption. Previous studies have shown that components of the endogenous digestive microflora, in particular Oxalobacter formigenes, utilize oxalate in the gut, thus limiting its absorption. We tested the hypothesis of whether oxaluria can be reduced by means of reducing intestinal absorption through feeding a mixture of freeze-dried lactic acid bacteria. METHODS Six patients with idiopathic calcium-oxalate urolithiasis and mild hyperoxaluria (>40 mg/24 h) received daily a mixture containing 8 x 10(11) freeze-dried lactic acid bacteria (L. acidophilus, L. plantarum, L. brevis, S. thermophilus, B. infantis) for four weeks. The 24-hour urinary excretion of oxalate was determined at the end of the study period and then one month after ending the treatment. The ability of bacteria to degrade oxalate and grow in oxalate-containing media, and the gene expression of Ox1T, an enzyme that catalyzes the transmembrane exchange of oxalate, also were investigated. RESULTS The treatment resulted in a great reduction of the 24-hour excretion of oxalate in all six patients enrolled. Mean levels +/- SD were 33.5 +/- 15.9 mg/24 h at the end of the study period and 28.3 +/- 14.6 mg/24 h one month after treatment was interrupted compared with baseline values of 55.5 +/- 19.6 mg/24 h (P < 0.05). The treatment was associated with a strong reduction of the fecal excretion of oxalate in the two patients tested. Two bacterial strains among those used for the treatment (L. acidophilus and S. thermophilus) proved in vitro to degrade oxalate effectively, but their growth was somewhat inhibited by oxalate. One strain (B. infantis) showed a quite good degrading activity and grew rapidly in the oxalate-containing medium. L. plantarum and L. brevis showed a modest ability to degrade oxalate even though they grew significantly in oxalate-containing medium. No strain expressed the Ox1T gene. CONCLUSIONS The urinary excretion of oxalate, a major risk factor for renal stone formation and growth in patients with idiopathic calcium-oxalate urolithiasis, can be greatly reduced with treatment using a high concentration of freeze-dried lactic acid bacteria. We postulate that the biological manipulation of the endogenous digestive microflora can be a novel approach for the prevention of urinary stone formation.
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Affiliation(s)
- C Campieri
- Department of Nephrology, S. Orsola University Hospital, Bologna, Italy
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Hassan I, Juncos LA, Milliner DS, Sarmiento JM, Sarr MG. Chronic renal failure secondary to oxalate nephropathy: a preventable complication after jejunoileal bypass. Mayo Clin Proc 2001; 76:758-60. [PMID: 11444411 DOI: 10.4065/76.7.758] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Enteric hyperoxaluria is a commonly seen adverse event after the jejunoileal bypass procedure. The increased concentration of urinary oxalate predisposes bypass patients to various renal complications such as nephrolithiasis and oxalate nephropathy. If not diagnosed and appropriately treated, these complications can lead to irreversible renal damage. We describe 3 patients in whom severe renal complications developed with irreversible compromise of renal function after a jejunoileal bypass. Patients who undergo a jejunoileal bypass require lifelong follow-up with close monitoring of their renal function. Marked decline in renal function mandates prompt investigation and aggressive intervention, including reversal of the jejunoileal bypass if necessary. Chronic renal failure secondary to oxalate nephropathy is preventable and treatable but may require conversion of a jejunoileal bypass to a more current form of bypass.
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Affiliation(s)
- I Hassan
- Department of Surgery, Mayo Clinic, Rochester, Minn 55905, USA
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17
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YAGISAWA TAKASHI, CHANDHOKE PARAMJITS, FAN JIE. COMPARISON OF COMPREHENSIVE AND LIMITED METABOLIC EVALUATIONS IN THE TREATMENT OF PATIENTS WITH RECURRENT CALCIUM UROLITHIASIS. J Urol 1999. [DOI: 10.1016/s0022-5347(05)68922-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- TAKASHI YAGISAWA
- From the Departments of Surgery (Urology) and Medicine (Renal Disease), University of Colorado Health Sciences Center, Denver, Colorado
| | - PARAMJIT S. CHANDHOKE
- From the Departments of Surgery (Urology) and Medicine (Renal Disease), University of Colorado Health Sciences Center, Denver, Colorado
| | - JIE FAN
- From the Departments of Surgery (Urology) and Medicine (Renal Disease), University of Colorado Health Sciences Center, Denver, Colorado
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COMPARISON OF COMPREHENSIVE AND LIMITED METABOLIC EVALUATIONS IN THE TREATMENT OF PATIENTS WITH RECURRENT CALCIUM UROLITHIASIS. J Urol 1999. [DOI: 10.1097/00005392-199905000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Bushinsky DA, Bashir MA, Riordon DR, Nakagawa Y, Coe FL, Grynpas MD. Increased dietary oxalate does not increase urinary calcium oxalate saturation in hypercalciuric rats. Kidney Int 1999; 55:602-12. [PMID: 9987084 DOI: 10.1046/j.1523-1755.1999.00281.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Human calcium oxalate (CaOx) nephrolithiasis may occur if urine is supersaturated with respect to the solid-phase CaOx. In these patients, dietary oxalate is often restricted to reduce its absorption and subsequent excretion in an effort to lower supersaturation and to decrease stone formation. However, dietary oxalate also binds intestinal calcium which lowers calcium absorption and excretion. The effect of increasing dietary oxalate on urinary CaOx supersaturation is difficult to predict. METHODS To determine the effect of dietary oxalate intake on urinary supersaturation with respect to CaOx and brushite (CaHPO4), we fed 36th and 37th generation genetic hypercalciuric rats a normal Ca diet (1.2% Ca) alone or with sodium oxalate added at 0.5%, 1.0%, or 2.0% for a total of 18 weeks. We measured urinary ion excretion and calculated supersaturation with respect to the CaOx and CaHPO4 solid phases and determined the type of stones formed. RESULTS Increasing dietary oxalate from 0% to 2.0% significantly increased urinary oxalate and decreased urinary calcium excretion, the latter presumably due to increased dietary oxalate-binding intestinal calcium. Increasing dietary oxalate from 0% to 2.0% decreased CaOx supersaturation due to the decrease in urinary calcium offsetting the increase in urinary oxalate and the decreased CaHPO4 supersaturation. Each rat in each group formed stones. Scanning electron microscopy revealed discrete stones and not nephrocalcinosis. X-ray and electron diffraction and x-ray microanalysis revealed that the stones were composed of calcium and phosphate; there were no CaOx stones. CONCLUSION Thus, increasing dietary oxalate led to a decrease in CaOx and CaHPO4 supersaturation and did not alter the universal stone formation found in these rats, nor the type of stones formed. These results suggest the necessity for human studies aimed at determining the role, if any, of limiting oxalate intake to prevent recurrence of CaOx nephrolithiasis.
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Affiliation(s)
- D A Bushinsky
- Nephrology Unit, University of Rochester, New York, USA.
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20
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Massey LK, Kynast-Gales SA. Substituting milk for apple juice does not increase kidney stone risk in most normocalciuric adults who form calcium oxalate stones. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1998; 98:303-8. [PMID: 9508013 DOI: 10.1016/s0002-8223(98)00071-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Increasing intake of dietary calcium from less than 400 mg to 800 mg daily may decrease the absorption of dietary oxalate, which in turn would decrease urinary oxalate excretion. The effect of substituting milk for apple juice on urine composition and risk of calcium oxalate precipitability was studied. SUBJECTS Twenty-one normocalciuric adults with a history of at least 1 calcium oxalate stone and urinary oxalate excretion exceeding 275 micromol/day on their self-selected diet. DESIGN Randomized crossover trial. INTERVENTION Each participant consumed two moderate-oxalate (2,011 micromol/day) study diets, which were identical except that one contained 360 mL milk and the other contained 540 mL apple juice as the beverage with meals. SETTING Four days free-living then 2 days in the metabolic unit of a university nutrition department. MAIN OUTCOME MEASURE Tiselius risk index for calcium oxalate precipitability calculated from urine composition. STATISTICAL ANALYSES Paired t tests. RESULTS Twenty-four hour urinary oxalate excretion was 18% lower (P<.0001) on the milk diet vs the juice diet: 423 vs 514 micromol, respectively. Calcium excretion was 17% higher (P<.05) on the milk vs juice diet: 4.7 vs 3.9 mmol, respectively. Urinary magnesium and citrate excretion, volume, and Tiselius risk index did not differ between diets. APPLICATIONS Substituting 360 mL milk daily for apple juice with meals in a diet containing moderate amounts of dietary oxalate from whole grains, legumes, fruits, and vegetables does not increase the risk index of calcium oxalate precipitability in most normocalciuric adults who form stones.
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Affiliation(s)
- L K Massey
- Department of Food Science and Human Nutrition, Washington State University, Spokane 99201-3899, USA
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21
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Laitinen J, Liesivuori J, Savolainen H. Urinary alkoxyacetic acids and renal effects of exposure to ethylene glycol ethers. Occup Environ Med 1996; 53:595-600. [PMID: 8882116 PMCID: PMC1128555 DOI: 10.1136/oem.53.9.595] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Ethylene glycol ethers and their acetates are widely used in industry, because of their hydrophilic and simultaneously lipophilic properties. Ethylene glycol ethers and their acetates are mainly metabolised to alkoxyacetic acids, but there is also a minor pathway through ethylene glycol to oxalic acid. The main pathway of ethylene glycol ethers is associated with significant clinical or experimental health effects and the minor pathway is also interesting because formation of urinary stones depends principally upon the urinary concentration of oxalate and calcium. METHODS Excretion of alkoxyacetic and oxalic acids was examined among silkscreen printers for an entire working week. The aim of the study was to evaluate alkoxyacetic acids as early indicators of exposure to glycol ethers and to evaluate their toxicity to kidneys. The load of alkoxyacetic and oxalic acids was compared with the excretion of calcium, chloride, ammonia, and glycosaminoglycans (GAG). Morning urine was chosen for the main analysis, as the overall metabolite, ethoxyacetic acid (EAA), has a long elimination time from the body. RESULTS The excretion of calcium increased according to the urinary alkoxyacetic acid load. The excretion of ammonia and chloride was higher among the exposed workers than among the controls. The highest urinary alkoxyacetic acid load was also associated with increased excretion of GAG, which may reflect the toxicity of metabolites of ethylene glycol ether. The excretion of GAG correlated positively with that of calcium in the printers with highest exposure. The tendency to form urinary stones was 2.4-fold higher among silkscreen printers than among office workers. CONCLUSION On the basis of renal effects our study indicates the need for establishing a new biological exposure limit before a workshift that is clearly below 100 mmol ethoxyacetic acids per mol creatinine in morning urine of people occupationally exposed to ethylene glycol ethers.
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Affiliation(s)
- J Laitinen
- Kuopio Regional Institute of Occupational Health, Finland
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22
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23
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Scheid C, Koul H, Hill WA, Luber-Narod J, Jonassen J, Honeyman T, Kennington L, Kohli R, Hodapp J, Ayvazian P, Menon M. Oxalate Toxicity in LLC-PK1 Cells, a Line of Renal Epithelial Cells. J Urol 1996. [DOI: 10.1016/s0022-5347(01)66402-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Cheryl Scheid
- Department of Physiology and the Division of Urologic and Transplantation Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Hari Koul
- Department of Physiology and the Division of Urologic and Transplantation Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - W. Adam Hill
- Department of Physiology and the Division of Urologic and Transplantation Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Judy Luber-Narod
- Department of Physiology and the Division of Urologic and Transplantation Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Julie Jonassen
- Department of Physiology and the Division of Urologic and Transplantation Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Thomas Honeyman
- Department of Physiology and the Division of Urologic and Transplantation Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Lori Kennington
- Department of Physiology and the Division of Urologic and Transplantation Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Rakhi Kohli
- Department of Physiology and the Division of Urologic and Transplantation Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - John Hodapp
- Department of Physiology and the Division of Urologic and Transplantation Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Philip Ayvazian
- Department of Physiology and the Division of Urologic and Transplantation Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Mani Menon
- Department of Physiology and the Division of Urologic and Transplantation Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
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Baker PW, Rofe AM, Bais R. Idiopathic calcium oxalate urolithiasis and endogenous oxalate production. Crit Rev Clin Lab Sci 1996; 33:39-82. [PMID: 8833627 DOI: 10.3109/10408369609101486] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Despite the great effort that has gone into investigating urolithiasis, this condition still persists as one of the major ailments of the urinary tract. Calcium oxalate urolithiasis is the most common form, accounting for some 60 to 80% of total stones. This review examines the elements (i.e., urine volume and pH and urinary excretion of calcium, oxalate, citrate, urate, magnesium, pyrophosphate, and glycosaminoglycans) that give rise to idiopathic calcium oxalate urolithiasis. Treatment strategies for idiopathic calcium oxalate urolithiasis, including lithotripsy, also are discussed. Urinary oxalate excretion is a major risk factor for calcium oxalate urolithiasis, with 85 to 95% of the urinary load derived endogenously. The factors controlling endogenous oxalate production are reviewed, including pathways for the diversion of glyoxylate from oxalate production. The use of beta-aminothiols and other substances to reduce endogenous oxalate production in subjects with idiopathic calcium oxalate urolithiasis is also discussed. A review of current methodologies for the determination of urinary oxalate is also included.
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Affiliation(s)
- P W Baker
- Institute of Medical and Veterinary Science, Adelaide, South Australia
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25
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Han JZ, Zhang X, Li JG, Zhang YS. The relationship of Oxalobacter formigenes and calcium oxalate calculi. JOURNAL OF TONGJI MEDICAL UNIVERSITY = TONG JI YI KE DA XUE XUE BAO 1995; 15:249-52. [PMID: 8731936 DOI: 10.1007/bf02887957] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The intestinal Oxalobacter Formigenes were isolated in 30 cases of urolithaiasis and in 45 controls. The biologic characters and morphology of the bacteria were also observed. The results showed that the colony counts in urolith group 9 (mean 10(3)/g. faeces) were significantly less than that of controls (mean 10(8)/g. faeces) (P < 0.001). It is believed that the lesser amount of oxalobacter formigenes in urolith was the important factor of the calcium oxalate calculi formation.
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Affiliation(s)
- J Z Han
- Department of Urology, Tongji Hospital, Tongji Medical University, Wuhan
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26
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Holmes RP, Goodman HO, Hart LJ, Assimos DG. Relationship of protein intake to urinary oxalate and glycolate excretion. Kidney Int 1993; 44:366-72. [PMID: 8377380 DOI: 10.1038/ki.1993.253] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The relationship of protein intake to urinary oxalate and glycolate excretion was examined in a large cohort (N = 101) of normal individuals on self-selected diets and in 11 individuals on controlled protein diets. On self-selected diets no correlation was detected between protein intake and urinary oxalate or glycolate excretion. A moderate but significant correlation (r = 0.45; P < 0.001) of oxalate with urea excretion was observed in males but not females, suggesting that there may be a link between urea and oxalate synthesis in males. On controlled protein diets mean oxalate excretion in females on days 7 to 10 of a high protein diet (1.8 g/kg body wt) was 20% higher than on a low protein diet (0.6 g/kg body wt; P = 0.02), but there was no difference in males. Glycolate excretion was significantly higher (P < 0.001) on the high protein diet than on the low protein diet in both sexes. Only a weak precursor-product relationship was observed between glycolate and oxalate. A gender effect was apparent on both self-selected and control diets with females excreting more oxalate and glycolate relative to creatinine than males. A pronounced inter- and intra-individual variability in the excretion of oxalate was observed, even on controlled diets. This suggests that genetic factors and physiological changes such as hormonal fluctuations may contribute more to the variability in oxalate excretion than the dietary intake of protein.
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Affiliation(s)
- R P Holmes
- Department of Urology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina
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27
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Massey LK, Roman-Smith H, Sutton RA. Effect of dietary oxalate and calcium on urinary oxalate and risk of formation of calcium oxalate kidney stones. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1993; 93:901-6. [PMID: 8335871 DOI: 10.1016/0002-8223(93)91530-4] [Citation(s) in RCA: 111] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Dietary restriction of oxalate intake has been used as therapy to reduce the risk of recurrence of calcium oxalate kidney stones. Although urinary oxalate is derived predominantly from endogenous synthesis, it may also be affected by dietary intake of oxalate and calcium. The risk of increasing urinary oxalate excretion by excessive consumption of dietary oxalate is greatest in individuals with a high rate of oxalate absorption, both with and without overt intestinal disease. Although oxalate-rich foods enhanced excretion of urinary oxalate in normal volunteers, the increase was not proportional to the oxalate content of the food. Only eight foods--spinach, rhubarb, beets, nuts, chocolate, tea, wheat bran, and strawberries--caused a significant increase in urinary oxalate excretion. Restriction of dietary calcium enhances oxalate absorption and excretion, whereas an increase in calcium intake may reduce urinary oxalate excretion by binding more oxalate in the gut. This review of the literature indicates that initial dietary therapy for stone-forming individuals can be limited to the restriction of foods definitely shown to increase urinary oxalate. The effects of oxalate-restricted diets on urinary oxalate should be evaluated by means of laboratory analyses of urine composition. Subsequent long-term therapy can be recommended if beneficial results are obtained from oxalate restriction at an appropriate calcium intake.
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Affiliation(s)
- L K Massey
- Washington State University, Spokane 99204-0399
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28
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Marangella M, Petrarulo M, Vitale C, Cosseddu D, Linari F. Plasma and urine glycolate assays for differentiating the hyperoxaluria syndromes. J Urol 1992; 148:986-9. [PMID: 1507356 DOI: 10.1016/s0022-5347(17)36796-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
To differentiate hyperoxaluria syndromes we measured plasma and urine glycolate by a novel high performance liquid chromatographic procedure. Mean glycolate level was 7.9 +/- 2.4 mumol./l. in plasma and 422 +/- 137 mumol./24 hours in urine from 19 control subjects. Renal clearance was about 50% the glomerular filtration rate irrespective of the underlying disease. There was close correlation between glycolate and oxalate in plasma. Plasma glycolate was normal in all but 8 patients who had primary hyperoxaluria 1. Plasma assay detected the disease more efficiently than urine assay. Pyridoxine decreased oxalate biosynthesis in 2 of the 4 patients treated with it and glycolate assay confirmed this behavior. Glycolate excretion was significantly high in 3 of 8 patients of primary hyperoxaluria 1 patients. Idiopathic stone formers had mild increases in glycolate excretion but this was not related with oxalate excretion. Glycolate levels were normal in 5 patients with enteric hyperoxaluria. We conclude that glycolate assay is essential for identifying patients with primary hyperoxaluria 1 and may represent a valuable tool for differentiating hyperoxaluria.
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Affiliation(s)
- M Marangella
- Renal Stone Laboratory, Ospedale Mauriziano Umberto I, Turin, Italy
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