oxalates and Celiac-Disease

During the last 10 years it has become apparent that hyperoxaluria often is present in malabsorptive states. This secondary hyperoxaluria could be explained by an increased uptake of dietary oxalate due to malabsorption of fatty acids and bile salts. Dietary prescriptions, including a low fat diet is advocated in the treatment of hyperoxaluria in Crohn's disease or after small bowel resection.

Topics: Aluminum Hydroxide; Bile Acids and Salts; Celiac Disease; Cholestyramine Resin; Colon; Crohn Disease; Diet; Humans; Malabsorption Syndromes; Oxalates; Taurine

Topics: Ascorbic Acid; Celiac Disease; Citrates; Colitis, Ulcerative; Crohn Disease; Dietary Fats; Gastrointestinal Diseases; Humans; Hyperparathyroidism; Ileostomy; Intestine, Small; Liver Diseases; Malabsorption Syndromes; Oxalates; Solubility; Urinary Calculi

Topics: Animals; Bile Acids and Salts; Blind Loop Syndrome; Breath Tests; Carbon Dioxide; Carbon Monoxide; Carbon Radioisotopes; Celiac Disease; Cholesterol; Dietary Fats; Digestive System; Dogs; Flatulence; Gastrointestinal Diseases; Guinea Pigs; Humans; Hydrogen; Ileum; Intestinal Absorption; Intestine, Small; Krypton; Lactose; Lactose Intolerance; Liver Circulation; Mannitol; Methane; Methods; Oxalates; Proteins; Radioisotopes; Rats

Topics: Bacteria; Bile Acids and Salts; Blind Loop Syndrome; Celiac Disease; Cholelithiasis; Diarrhea; Humans; Ileum; Intestinal Absorption; Intestinal Diseases; Intestine, Small; Kidney Calculi; Malabsorption Syndromes; Oxalates; Postoperative Complications; Vitamin B 12 Deficiency

Topics: Bile Acids and Salts; Biliary Tract Diseases; Blind Loop Syndrome; Celiac Disease; Chenodeoxycholic Acid; Cholelithiasis; Cholesterol; Cholic Acids; Deoxycholic Acid; Diarrhea; Glycine; Humans; Intestinal Absorption; Intestinal Obstruction; Lithocholic Acid; Liver; Liver Circulation; Oxalates; Stomach Ulcer; Taurine

Oxalate nephropathy, due to secondary hyperoxaluria has widely been described in gastrointestinal diseases. However, reports of oxalate nephropathy in newly diagnosed celiac disease are rare. A 72-year-old Caucasian male presented to the hospital with abdominal discomfort and acute renal insufficiency with a creatinine of 290 µmol/L. The clinical course, laboratory results and urinalysis were suspect for tubular injury. Renal biopsy showed calcium oxalate depositions. Elevated plasma and urine oxalate levels established the diagnosis oxalate nephropathy. The abdominal complaints with steatorrhea and positive anti-tissue transglutaminase antibodies were diagnosed as celiac disease, which was confirmed after duodenal biopsies. Treatment with prednisone, and gluten-free, low oxalate and normal calcium diet, lowered the plasma oxalate levels and improved his renal function. Decreased absorption of free fatty acids can lead to increased free oxalate in the colon due to the binding of free fatty acids to calcium, preventing the formation of the less absorbable calcium oxalate in the colon. Oxalate dispositions in the kidney can lead to acute tubular injury and chronic renal insufficiency. Celiac disease is therefore one of the intestinal diseases that can lead to hyperoxaluria and oxalate nephropathy.

Topics: Acute Kidney Injury; Aged; Calcium; Calcium Oxalate; Celiac Disease; Fatty Acids, Nonesterified; Humans; Hyperoxaluria; Male; Oxalates

Intestinal malabsorption can cause urinary stone disease via enteric hyperoxaluria. It has been shown that celiac disease, a common malabsorption disorder, is associated with an increased risk of calcium oxalate kidney stones in adults. Since no published data are available in the pediatric population, we analyzed urinary excretion of electrolytes in children with celiac disease to assess the risk of nephrolithiasis.. The study population consisted of 115 children 1 to 16 years old (mean 5 years) with positive serological tests for celiac disease (anti-endomysium and anti-tissue transglutaminase antibodies) referred to us for jejunal biopsy to confirm the diagnosis. Assessment was requested because patients presented with poor growth, anemia, gastrointestinal disorders or a family history of celiac disease. After obtaining informed consent we performed urine tests to measure urinary variables and blood tests to exclude metabolic disorders and evaluate renal function.. All patients had a biopsy confirmed diagnosis of celiac disease. Oxaluria was normal in all children studied. However, levels of urinary calcium were decreased in patients with celiac disease and were inversely associated with disease severity (p = 0.0004).. In contrast to adults, increased urinary excretion of oxalate was not detectable in children presenting with celiac disease. Therefore, the risk of nephrolithiasis appears not to be increased compared to healthy children. The observed hypocalciuria probably further decreases the tendency to form kidney stones.

Topics: Adolescent; Age Factors; Calcium; Celiac Disease; Child; Child, Preschool; Creatinine; Female; Humans; Infant; Magnesium; Male; Nephrolithiasis; Oxalates; Phosphorus; Reference Values; Risk Factors

Decreased kidney function from kidney deposition of calcium oxalate has been described previously in inflammatory bowel disease and after jejuno-ileal and Roux-en-Y gastric bypass surgeries. Although celiac disease is the most prevalent bowel abnormality associated with intestinal malabsorption, its relationship to high kidney oxalate burden and decreased kidney function has not been established. We report a case of subclinical celiac disease and hyperoxaluria that presented with loss of kidney function as a result of high oxalate load in the absence of overt diarrhea, documented intestinal fat malabsorption, and nephrolithiasis. Subclinical celiac disease is commonly overlooked and hyperoxaluria is not usually investigated in kidney patients. We propose that this entity should be suspected in patients with chronic kidney disease in which the cause of kidney damage has not been clearly established.

Topics: Celiac Disease; Creatinine; Female; Humans; Hyperoxaluria; Immunohistochemistry; Kidney Diseases; Kidney Transplantation; Kidney Tubules; Malabsorption Syndromes; Membrane Transport Proteins; Middle Aged; Oxalates; Sulfate Transporters

A 37-year-old patient underwent two successive renal transplantations 7 months apart. He remained dialysis dependent. Early biopsy of both grafts revealed widespread calcium oxalate deposition suggestive of acute oxalate nephropathy. Several causes of oxalate nephropathy, including primary oxalosis and an increased intake of oxalic acid precursors, were excluded. Two years later, the identification of steatorrhea with radiologic signs of chronic pancreatitis led to the hypothesis of enteric hyperoxaluria. Surprisingly, 11 months after the second transplantation, graft function improved progressively allowing interruption of dialysis. Three years later, renal function is stable. The causes and prevention of acute oxalate-induced graft failure are highlighted. Subclinical evidence of enteric hyperoxaluria should be looked for and appropriate therapy instituted as early as possible. The possibility of a late recovery of renal function warrants attentive patience from attending physicians.

Topics: Acute Kidney Injury; Adult; Celiac Disease; Chronic Disease; Humans; Hyperoxaluria; Kidney; Kidney Transplantation; Klinefelter Syndrome; Male; Oxalates; Pancreatitis; Reoperation; Treatment Failure; Treatment Outcome

Data presented here showed that oxalate loading test--a technique for diagnosis of steatorrhoea is not applicable if the patient is also suffering with diabetes. In vitro experiments showed that sugar interferes in oxalate assay.

Topics: Blood Glucose; Celiac Disease; Diabetes Complications; Humans; Oxalates

Topics: Adolescent; Adult; Aged; Celiac Disease; Creatinine; Feces; Humans; Lipids; Middle Aged; Oxalates; Oxalic Acid

We have evaluated two procedures as screening tests for steatorrhoea: firstly, a simplified, two-day, oxalate-loading test and secondly the rate of urinary oxalate excretion following a single oral dose of oxalate. Following two-day oxalate loading there was almost complete overlap of the values for 24-h urinary oxalate between 15 apparently healthy volunteers and 10 patients with steatorrhoea. The rate of oxalate excretion following a single dose of oxalate was increased in one patient with Crohn's disease and ileal resection who had normal faecal fat excretion, but three patients with steatorrhoea due to other causes had normal rates of excretion. We conclude that these oxalate-loading tests are not a useful alternative to faecal fat estimation in patients with suspected malabsorption.

Topics: Adult; Aged; Celiac Disease; Creatinine; Fats; Feces; Female; Humans; Male; Metabolic Clearance Rate; Middle Aged; Oxalates

Different screening tests for fat malabsorption were evaluated in patients with coeliac disease. The triolein breath test correlated well with results of faecal fat determination. Urinary excretion of oxalate with or without dietary oxalate loading was not correlated with faecal fat measurements. It is concluded that the triolein breath test is a useful procedure for the detection of fat malabsorption in patients with coeliac disease.

Topics: Adult; Aged; Breath Tests; Celiac Disease; Dietary Fats; Female; Humans; Intestinal Absorption; Lipids; Male; Middle Aged; Oxalates; Triolein

Ten patients with familial hypercholesterolaemia were subjected to partial ileal by-pass surgery. Plasma cholesterol fell by 41 and 38% and low-density lipoprotein cholesterol by 51 and 46% after six and 18 months respectively. High-density and very low-density lipoprotein cholesterol and plasma triglycerides were unaffected. Alanine aminotransferase increased transiently in half of the patients. Diarrhoea and slight steatorrhoea troubled most of the patients for the duration of 18 months' period of observation. Other long-term side effects were slight but significant increase in the renal excretion of oxalic acid and reduction in the intestinal absorption of calcium. The study shows that this operation has metabolic side-effects that warrant continued medical care of these patients.

Topics: Adult; Calcium, Dietary; Celiac Disease; Cholesterol; Diarrhea; Female; Humans; Hyperlipoproteinemia Type II; Ileum; Intestinal Absorption; Jejunum; Lipoproteins; Male; Middle Aged; Oxalates; Oxalic Acid; Postoperative Complications; Postoperative Period; Triglycerides

Topics: Bile Acids and Salts; Bile Duct Diseases; Celiac Disease; Humans; Oxalates

Because of their amphiphilic properties, bile acids have important physiological functions. However, they can also be pathogenetically active. Some recent findings on the biochemistry and enterohepatic circulation of bile acids are presented. In contrast to the adult liver where the only primary bile acids formed are cholic- and chenodeoxycholic acid, the foetal liver is able to synthesise a variety of "atypical" bile acids. Under certain circumstances, a retrograde differentiation is possible in the adult. The very effective transport systems in gut and in the sinusoidal and canalicular membrane of the liver cell limit the bile acids almost exclusively to the enterohepatic circulation. During transport in blood, through biomembranes and in the liver cytosol, bile acids are bound to carrier proteins. The carrier has been detected using photoaffinity labelling. Following biotransformation (sulphation and glucuronidation) pathogenetically active bile acids can be converted into derivatives which can be rapidly eliminated. Disturbances of these mechanisms result in functional defects and diseases. The pathological significance of bile acids in hepato-biliary diseases is represented with regard to the cholestatic and proliferative effect of individual bile acids. The significance of bile acids in chologenic diarrhea, steatorrhea and enteral hyperoxaluria are presented as examples of the pathogenetic effects of bile acids on the gut. In these diseases it is possible to recognise the specific effects of certain bile acids on the colon mucosa. Recent studies have demonstrated that bile acids are possibly of pathogenetic significance in the case of epidemiologically proven relationship between colon carcinoma and high fat, high cholesterol and low fibre diets.

Topics: Bile Acids and Salts; Biliary Tract Diseases; Biological Transport, Active; Carrier Proteins; Celiac Disease; Cholestasis; Colonic Neoplasms; Cytosol; Diarrhea; Humans; Intestinal Absorption; Kidney Calculi; Lipoproteins, HDL; Liver; Liver Diseases; Molecular Weight; Oxalates

The authors report the association, in a 64-year old man with previous large ileal resection (110 cm) for Crohn's disease, of gallstone and oxalate renal stones. The oxaluria was 60 mg per day (normal, less than 25 mg) and the fecal fat excretion was 50 g per day (normal, less than 6 g). A low--oxalate and--fat diet for 3 months reduced dramatically the steatorrhea, but was totally ineffective for the reduction of hyperoxaluria. The physiopathological mechanisms and the therapeutic consequences of these metabolic complications of ileal resections are discussed.

Topics: Celiac Disease; Cholelithiasis; Crohn Disease; Humans; Ileum; Kidney Calculi; Male; Middle Aged; Oxalates; Postoperative Complications

Topics: Adult; Calcium; Celiac Disease; Female; Humans; Ileum; Intestinal Absorption; Jejunum; Lipid Metabolism; Male; Middle Aged; Obesity; Oxalates; Postoperative Complications; Prospective Studies

To investigate the possibility of measuring urinary oxalate output instead of faecal fat excretion as an outpatient screening test for steatorrhoea, we determined 24 hour urinary oxalate and five day faecal fat excretion before and during an oral load of sodium oxalate 600 mg daily (oxalate 4.44 mmol), in 32 patients with suspected malabsorption on a diet containing oxalate 30 mg (0.33 mmol), fat 50 g (180 mmol), and calcium 1 g (25 mmol). Nineteen patients proved to have steatorrhoea (mean faecal fat 62 mmol/24 h, range 19--186 mmol) of varying aetiologies. On the diet alone, urinary oxalate was raised in only nine of these patients (mean 0.25 mmol/24 h, range 0.08--0.59 mmol) (normal less than 0.20). By contrast, when the diet was supplemented with oral sodium oxalate, all 19 patients with steatorrhoea had hyperoxaluria (mean 0.91 mmol/24 h, range 0.46--1.44 mmol) (normal less than 0.44). There was a significant positive linear relationship between urinary oxalate and faecal fat when the 32 patients were on the high oxalate intake (r = 0.73, P less than 0.001), but not when they were on the low oxalate intake. Mean percentage absorption of orally administered oxalate was 5.8 +/- 0.99% (+/- 1 SD) in normal subjects and 14.7 +/- 6.0% (P less than 0.002) in patients with steatorrhoea. Measurement of urinary oxalate output during oral sodium oxalate loading appears to be a reliable and convenient screening test for steatorrhoea.

Topics: Adult; Aged; Celiac Disease; Feces; Glycolates; Humans; Intestinal Absorption; Lipids; Middle Aged; Oxalates

This work was designed to investigate the site of oxalate hyperabsorption in malabsorption syndromes. 1) Urinary oxalate excretion was measured in 27 patients with ileal resection (IR) and steatorrhea. Mean urinary oxalate excretion was high in 13 patients with IR and intact colon and in 9 subjects with IR and right hemicolectomy (90.2 +/- 11.9 and 108 +/- 18.6 mg per 24 hours; mean +/- S.E.M.), whereas it was normal in 5 patients with IR and ileostomy (21.9 +/- 4.4 mg per 24 hours). Steatorrhea was similar in the three groups. 2) On one patient of the last group in whom the colon had not been removed initially but excluded closure of the ileostomy resulted in the development of frank hyperoxaluria. 3) Intracolonic perfusion of calcium (1.93 g per day) abolished or greatly reduced the hyperoxaluria in 3 patients. These results indicate that the colon is the major site of oxalate hyperabsorption, and the right colon is not necessary for the development of hyperoxaluria in malabsorption syndromes.

Topics: Calcium; Celiac Disease; Colectomy; Colon; Feces; Humans; Ileostomy; Intestinal Absorption; Lipids; Malabsorption Syndromes; Oxalates

Oxalate-urolithiasis and hyperoxalaria have been reported to be a frequent complication in patients with small bowel disease, especially in patients with ileal resection due to Crohn's disease. Hyperabsorption of oxalate seems to be the main patholgenetic factor for "enteric" hyperoxalaria. Intestinal absorption and urinary excretion of oxalate was measured in patients with various gastrointestinal diseases after oral or rectal administration of 14C-oxalate. Kinetic data suggest that 14C-oxalate is absorbed in the small, the large bowel and the rectum as well. Oxalate absorption was decreased in patients with a colectomy and in active ulcerative colitis, but increased in patients with ileal resection, chronic liver disease, and steatorrhea due to chronic pancratitis or sprue. There existed a positive correlation between 14C-oxalate absorption and the amount of fecal fat excretion. The data suggest that hyperoxaluria and hyperabsorption of oxalate are not a specific finding in patients with bile acid malabsorption, but may occur too, in steatorrhea without alteration of bile acid metabolism.

Topics: Celiac Disease; Chronic Disease; Colitis, Ulcerative; Colon; Gastrointestinal Diseases; Humans; Ileum; Intestinal Absorption; Liver Diseases; Oxalates; Pancreatitis; Postoperative Complications; Rectum; Urinary Calculi

The importance of intestinal resection, exclusion of the colon, and steatorrhoea for secondary hyperoxaluria was studied in 81 patients with Crohn's disease and 12 patients with ileostomy after colectomy for ulcerative colitis during a metabolic regime including a fixed oral supply of fat, calcium, and oxalate. Hyperoxaluria (greater than 48 mg (greater than 0.5 mmol) per 24 h) was present in 21 patients with Crohn's disease. All but one half or more of the colon preserved. Renal oxalate excretion was related to the amount of ileum resected. 14C-oxalate absorption was significantly higher in patients with ileal resection and the whole colon preserved than in patients with ileal resection plus hemicolectomy, despite the fact that the latter group had the most extensive ileal resections. Faecal fat and oxalate excretion agreed well in patients without ileostomy (r = 0.76, p less than 0.001), and renal oxalate excretion was significantly higher in patients with steatorrhea and the colon preserved than in patients without steatorrhoea. In all 93 patients 14C-oxalate absorption and renal oxalate excretion was positively correlated with a coefficient of correlation of 0.76 (p less than 0.001). No correlation was present between 47Ca- and 14C-oxalate absorption. The study confirm that a preserved colon is necessary for secondary hyperoxaluria and stresses the importance of ileal resection and steatorrhoea.

Topics: Adult; Aged; Celiac Disease; Child; Colectomy; Crohn Disease; Fats; Female; Humans; Ileostomy; Ileum; Intestinal Absorption; Jejunum; Kidney; Male; Middle Aged; Oxalates

Topics: Amyloidosis; Bile Acids and Salts; Celiac Disease; Cholelithiasis; Cholestyramine Resin; Colitis, Ulcerative; Crohn Disease; Gastrointestinal Diseases; Glycine; Hepatic Encephalopathy; Humans; Kidney Calculi; Kidney Diseases; Kidney Failure, Chronic; Malabsorption Syndromes; Oxalates; Proteinuria

100 g of spinach a day was added to the hospital diet of fifty-four patients with suspected malabsorption. Hyperoxaluria was found in thirty-eight patients; all of them had steatorrhoea. No patient with steatorrhoea had a urinary oxalate excretion of less than 40 mg a day. Ten other patients had hyperoxaluria, but the faecal fat determinations were regarded as unreliable in almost all and malabsorption could not be confirmed. It is suggested that in clinical practice determination of urinary oxalate after an oral load of oxalate could replace faecal fat determination in most patients with suspected malabsorption.

Topics: Adolescent; Adult; Aged; Carcinoma; Celiac Disease; Chronic Disease; Crohn Disease; Diet; Feces; Humans; Hypoparathyroidism; Lipids; Liver Cirrhosis; Middle Aged; Oxalates; Pancreatitis; Peptic Ulcer; Thyroid Neoplasms; Vegetables

To investigate the role of the colon in increased oxalate absorption, we measured urinary oxalate and fecal fat excretion in 26 patients with gastrointestinal disease. Eight patients with steatorrhea of various causes (Crohn's disease [two], chronic pancreatitis [four], jejunoileal bypass [one] and extrahepatic biliary obstruction [one]) had hyperoxaluria (greater than 45 mg per 24 hours). All these patients had intact colons. In contrast, none of five patients with ileostomies and steatorrhea secondary to ileal resection had hyperoxaluria. Absorption of 14C-oxalate was increased in three patients with steatorrhea and intact colons but not in three patients with steatorrhea and an ileostomy. Thus, the colon is both the site of and required for increased oxalate absorption in enteric hyperoxaluria. The lack of a direct relation between fecal fat excretion and urinary oxalate excretion in the patients with hyperoxaluria and steatorrhea suggests that steatorrhea, although important, is not the only determinant in the pathogenesis of hyperoxaluria.

Topics: Celiac Disease; Colon; Crohn Disease; Humans; Intestinal Absorption; Lipid Metabolism; Oxalates; Pancreatitis

Patients with ileal disease, ileal resection, and jejunoileal bypass are at increased risk of forming calcium oxalate renal calculi because of enhanced absorption of dietary oxalate. Intraluminal solubility of oxalate is an important determinant for hyperabsorption and may be regulated by intraluminal concentration of calcium and fatty acids. Malabsorbed bile salts and fatty acids may alter intestinal permeability, leading to increased passive diffusion of oxalate. Management includes a diet low in oxalate and fat content, dietary calcium of 750 mg/day, and cholestyramine.

Topics: Bile Acids and Salts; Calcium; Calcium, Dietary; Celiac Disease; Cholestyramine Resin; Dietary Fats; Fatty Acids; Humans; Ileum; Intestinal Diseases; Intestinal Mucosa; Jejunum; Kidney Calculi; Obesity; Oxalates

The effect of fat malabsorption on the absorption and renal excretion of dietary oxalate was studied in four patients with sprue and in two patients with dermatitis herpetiformis and sprue-like jejunal histology. Hyperoxaluria was present in all patients with sprue when fat malabsorption was severe. Urinary oxalate excretion decreased in two of the three patients with coeliac sprue when their fat malabsorption had improved after three months of dietary gluten restriction. Neither patient with dermatitis herpetiformis and sprue had steatorrhoea. In these patients, urinary oxalate excretion was always within normal limits. A significant positive linear relationship (y=28.25 +4-84x; r=0-82; P less than 0-01) was demonstrated between faecal fat and urinary oxalate excretion. The results of this study support the concept that severe malabsorption of dietary fat plays a primary causative role in enteric hyperoxaluria.

Topics: Calcium; Celiac Disease; Dermatitis Herpetiformis; Dietary Fats; Fats; Feces; Glutens; Humans; Jejunum; Oxalates

Hyperoxaluria was documented in patients with pancreatic insufficiency, adult celiac disease, regional enteritis after ileectomy and partial colectomy, and jejunoileal bypass. The degree of hyperoxaluria correlated directly with the severity of the steatorrhea and inversely with the dietary calcium content. High-calcium diets suppressed oxalate excretion to normal when fecal fat excretion was approximately 30 g/day or less. In patients with more severe steatorrhea, decreasing dietary fat and oxalate content further reduced urinary oxalate excretion. These data suggest that, while steatorrhea is the most important determinant for enhanced absorption of dietary oxalate, variations in dietary calcium content modulate the amount of oxalate absorbed.

Topics: Adult; Aged; Calcium, Dietary; Celiac Disease; Crohn Disease; Female; Humans; Ileum; Intestinal Absorption; Intestinal Diseases; Intestines; Jejunum; Malabsorption Syndromes; Male; Middle Aged; Oxalates

Topics: Bacteria; Bile Acids and Salts; Biliary Tract Diseases; Celiac Disease; Cholelithiasis; Cholestyramine Resin; Colon; Diarrhea; Diet; Enterohepatic Circulation; Fecal Impaction; Gastrointestinal Motility; Humans; Hydrogen-Ion Concentration; Ileum; Intestinal Absorption; Intestines; Neomycin; Oxalates; Triglycerides; Water-Electrolyte Balance

Urinary oxalate excretion was measured in healthy persons and patients with Crohn's disease, colitis ulcerosa, sprue and other diseases accompanied with malabsorption, and patients with insufficiency of the exocrine pancreas gland. Further measurements were made in patients after resection of parts of the small intestine or the colon. We found a clear increase of urinary oxalate excretion in patients with resected parts of the small intestine, sprue or other malabsorption syndromes. In 4 patients with resected parts of small intestine or pancreas we even found urolithiasis. Urinary oxalate excretion correlated significantly with steatorrhoea and increased if larger parts of small intestine were resected. Increased resorption of oxalate from food causes increased urinary excretion. Details about the patho-mechanism of this increased excretion are not known yet; an important factor seems to be the reduced absorption of fat in the small intestine.

Topics: Adult; Celiac Disease; Colitis, Ulcerative; Crohn Disease; Feces; Female; Humans; Intestinal Diseases; Intestine, Large; Intestine, Small; Lipids; Malabsorption Syndromes; Male; Middle Aged; Oxalates; Pancreatic Diseases; Urinary Calculi

24-hour urinary outputs of oxalate, calcium, and magnesium have been determined in a total of 62 children aged 3 months to 17 years who fell into the following groups: (i) 16 normal controls, (ii) 3 with primary hyperoxaluria, (iii) 9 with small and/or large intestinal resections, (iv) 9 with untreated coeliac disease, (v) 5 with pancreatic dysfunction, and (vi) a miscellaneous group of 20 children with a variety of intestinal disorders. Taken as a whole, 58% of patients with intestinal disorders had hyperoxaluria, and of these 7% had urinary outputs of oxalate which fell within the range seen in primary hyperoxaluria. The proportion of children with hyperoxaluria in the different diagnostic groups was as follows: intestinal resections (78%), coeliac disease (67%), pancreatic dysfunction (80%), and miscellaneous (45%). 35% of the patients with hyperoxaluria had hypercalciuria, whereas magnesium excretion was normal in all subjects studied. In 2 patients treatment of the underlying condition was accompanied by a return of oxalate excretion to normal. These results indicate that hyperoxaluria and hypercalciuria are common in children with a variety of intestinal disorders, and that such children may be at risk of developing renal calculi without early diagnosis and treatment.

Topics: Adolescent; Calcium; Celiac Disease; Child; Child, Preschool; Colon; Glutens; Humans; Infant; Intestinal Absorption; Intestinal Diseases; Kidney Calculi; Liver Diseases; Magnesium; Oxalates; Pancreatic Diseases

Clinical studies suggest that steatorrhoea can be associated with excessive absorption of dietary oxalate. We examined the influence of bile salts, Ca++, and long-chain fatty acid on the absorption of oxalate and water by rat intestine in vivo. Absorption was measured under steady-state conditions during single-pass infusions. Each intestinal segment served as its own control. In jejunum, 10 mM taurocholate, the principal salt in rat bile, depressed absorption of oxalate and water. Absorption was not depressed further by Ca++ or linoleic acid. In ileum, 10 mM taurocholate did not inhibit absorption. Linoleic acid, 2 mM, depressed absorption of both oxalate and water. In colon 10 mM taurocholate decreased absorption. Net water transport was depressed further when linoleic acid was added to the infusion, but oxalate absorption was enhanced. Ca++ negated these effects of linoleic acid. It is concluded that long-chain fatty acids may enhance the absorption of oxalate from the rat colon. This observation may be relevant to understanding hyperoxaluria in patients with steatorrhoea.

Topics: Animals; Calcium; Celiac Disease; Colon; Depression, Chemical; Ileum; Intestinal Absorption; Jejunum; Linoleic Acids; Male; Oxalates; Rats; Taurocholic Acid; Water