oxalates and Colitis--Ulcerative

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

There is a definite increased incidence of calculi associated with extensive small bowel disease or resection. Hyperoxaluria appears to play a major role and may be due to increased intestinal oxalate absorption. Forced fluids and dietary discretion are mainstays of stone prophylaxis.

Topics: Bile Acids and Salts; Calcium; Carbon Radioisotopes; Colitis, Ulcerative; Crohn Disease; Enteritis; Humans; Intestine, Small; Intestines; North Carolina; Obesity; Oxalates; Radiotherapy; Urinary Calculi

To correlate renal calculi and other clinical factors with urinary biochemical analytes in patients with inflammatory bowel disease, and to investigate the relative importance of hyperoxaluria (associated with fat malabsorption) or reduced stone inhibitors in the development of calculi in these patients.. Samples were obtained from 25 patients with Crohn's disease (CD), 15 with ulcerative colitis (UC) and 17 normal subjects (controls). Evidence for the presence of renal calculi was obtained from plain films, ultrasonography or intravenous urography. Urine oxalate and citrate were analysed using commercial enzymatic assays; magnesium was measured using atomic absorption and other analytes assayed using standard methods on automated analysers.. Renal calculi were found in two patients with CD and in none with UC. Hyperoxaluria was present in 36% of patients with CD but was absent in those with UC. Analysis of covariance showed an association between low urinary citrate/creatinine ratio and renal stones (P=0.02), and between a combined urinary citrate and magnesium deficit relative to calcium, as expressed in the CMC index ((citratexmagnesium)/calcium), and renal stones (P=0.017). Changes in urinary calcium, oxalate, urate, magnesium or the calcium oxalate index were not associated with the presence of stones. There was no independent relationship between any clinical factor and the presence of stones.. Lower urinary concentrations of magnesium and citrate (stone inhibitors), relative to calcium (stone promoter; the CMC index) may be more important in lithogenesis in inflammatory bowel disease than is hyperoxaluria. In patients with a functioning colon, a low CMC index may predict likely stone-formers; this requires a prospective evaluation. Avoiding low urinary levels of magnesium and citrate may aid in preventing and treating renal calculi.

Topics: Acute-Phase Proteins; Adult; Aged; C-Reactive Protein; Citrates; Colitis, Ulcerative; Creatinine; Crohn Disease; Female; Humans; Hyperoxaluria; Kidney Calculi; Magnesium; Malabsorption Syndromes; Male; Middle Aged; Oxalates; Risk Factors; Serum Albumin

Urolithiasis is a disease of a complex, often systemic and not fully unequivocal, etiopathological mechanism, resulting in concrement crystallization The aim of study was the evaluation of frequency of occurrences of crystallization risk states and urolithiasis in children with IBD.. The study was conducted on 35 children aged between 12 and 18 with confirmed ulcerative colitis (25 children) and Crohn disease (10 children). In all children regiular urine examination and urine inoculation were conducted, as well as stimation of concrement crystallization risk index in a twenty-four hour urine collection. Urinary tract ultrasound as well as evaluation of erythrocytes in urine sediment in phase contrast microscope,have been performed. Control group consisted of 20 children without digestive tract complains.. In 13 (37%) of examined children, urolithiasis occured in family history. The general urine examination revealed in 27 (77%) examined children existence of erytrocyturia of various degree and the evaluation in phase contrast microscope indicated their extraglomucal origin. The ion-creatininal analysis of twenty-four hour urine collection revealed in 29 (82.2%) children risk of oxalate-calcium concrements crystallization and in 6 (17%) children--of oxalate concrements crystallization. USG examination revealed in 4 (11.4%) children existence of single or multiple concrements in urinary system. Analysis of 1 twenty-four hour urine collection indicated the decrease of magnesium ions in 27 (77%) examined children. In control group only in 2 (5.7%) children the risk of occurrence of phosphate-ammonium concrements crystallization, which was significantly lower in examined group (p < 0.01).. Unspecific intestine inflammations have an influence on the occurrence of crystallization risk states, as well as a fully symptomatic urolithiasis.

Topics: Adolescent; Calcium Oxalate; Colitis, Ulcerative; Crohn Disease; Crystallization; Female; Hematuria; Humans; Inflammatory Bowel Diseases; Lithiasis; Magnesium; Male; Oxalates; Oxalic Acid; Risk Factors; Urinary Calculi; Urine; Urolithiasis

The aim of this study was to analyze the frequency of renal stone patients with chronic inflammatory bowel disease and their urinary patterns.. During a 20-year period, 1941 consecutive patients with renal stone disease underwent routine laboratory procedures including a fasting blood sample for chemistry profile and a 24-hour urine collection for analyses of electrolytes. Thorough histories including chronic inflammatory disease or ileal resection were obtained. Patients with inflammatory bowel disease together with a control group comprising 47 idiopathic renal calcium stone formers were submitted to a xylose absorption test for evaluation of intestinal absorption.. We observed 10 patients with Crohn's disease, 12 with ulcerative colitis and one patient with ileal bypass for obesity. Six patients underwent ileal resection and 10 patients total colectomy. Urinary oxalate excretion was significantly higher and urinary citrate lower in stone patients with ileal disease (Ox 60 +/- 23, Cit 113 + 7-118 mg/day) than in idiopathic stone formers (Ox 28.2 +/- 11.5, Cit 381 +/- 205) and stone patients with ulcerative colitis (Ox 20.3 +/- 14.8, Cit 369 +/- 247). Urinary volume was significantly lower in patients with ulcerative colitis. A significant inverse correlation (-0.38, p < 0.01) between oxalate urinary excretion and blood xylose level was found 2 hours after ingestion of xylose. No significant reduction of xylose absorption was demonstrated in both normoxaluric and hyperoxaluric idiopathic stone patients.. Crohn's disease and ulcerative colitis are characterized by recurrent inflammatory involvement of different intestinal segments involving distinctive urinary patterns. Malabosorption associated with ileal disease causes increased oxalate absorption by increasing oxalate solubility in the intestinal lumen and permeability of the colonic mucosa; a reduced citrate excretion is associated in relation to mild acidosis due to the loss of bicarbonate in the liquid stool. In ulcerative colitis, especially if an ileostomy is present, urine are scanty and concentrated, and urine pH falls, leading to uric acid or mixed stones. Mild hyperoxaluria of idiopathic renal stone formers is not related to subtle intestinal malabsorption.

Topics: Adult; Bile Acids and Salts; Calcium; Citrates; Colectomy; Colitis, Ulcerative; Crohn Disease; Diuresis; Female; Humans; Hydrogen-Ion Concentration; Ileum; Inflammatory Bowel Diseases; Intestinal Absorption; Kidney Calculi; Malabsorption Syndromes; Male; Middle Aged; Oxalates; Prevalence; Retrospective Studies; Solubility; Xylose

Nephrolithiasis occurs in 5 to 13% of patients with ulcerative colitis (UC) who undergo colectomy and abdominal ileostomy, presumably from chronic dehydration and urinary concentration. Whether endorectal ileal pullthrough with ileal reservoir (PTR) changes the incidence of stones (primarily calcium oxalate) after colectomy is not known. Urinary excretion of Na2+, K+, Ca2+, Mg2+, phosphate, urate, oxalate, and citrate was measured in a prospective study of 12 UC patients undergoing PTR with temporary end ileostomy. Twenty-four-hour urine samples were obtained before colectomy (t1), after colectomy but before ileostomy closure (t2), and 5 months after ileostomy closure (t3). Urine volumes decreased from 831 +/- 101 cc (mean +/- SE) at t1 to 715 +/- 101 cc at t2 and then increased to 1278 +/- 421 cc at t3 (significant, with P less than 0.01 by t test). Urinary excretions of Mg2+, oxalate, and citrate were low in UC patients compared to those in controls (15 healthy adult volunteers). Excretion of Ca2+ increased significantly following temporary ileostomy while excretion of Mg2+ fell. Excretion of Ca2+ fell and excretion of Mg2+ and citrate increased following PTR. We conclude that PTR patients have increased urine volumes and urinary ion changes known to decrease the risk of developing renal stones.

Topics: Adolescent; Adult; Citrates; Citric Acid; Colectomy; Colitis, Ulcerative; Electrolytes; Female; Humans; Hydrogen-Ion Concentration; Ileum; Kidney Calculi; Male; Middle Aged; Oxalates; Prospective Studies; Uric Acid

Six children with inflammatory bowel disease and nephrolithiasis are reported. Their mean age at the passage of the first stone was 12.5 years and the mean duration of active inflammatory bowel disease was 34.5 months. Four had ulcerative colitis and two had Crohn's disease. In three patients, the onset of stone disease was associated with a flare in the bowel disease. Stone passage in four patients was accompanied by an increase in abdominal pain; three experienced gross hematuria. Stones from four of the patients were composed primarily of calcium phosphate; stones from the remaining patients contained uric acid and/or calcium oxalate. The pathogenesis of nephrolithiasis as it relates to inflammatory bowel disease is considered and an approach to therapy offered.

Topics: Adolescent; Calcium; Calcium Phosphates; Child; Citrates; Citric Acid; Colitis, Ulcerative; Crohn Disease; Crystallization; Diphosphates; Female; Humans; Kidney Calculi; Magnesium; Male; Oxalates; Oxalic Acid; Uric Acid

In a group of 112 patients with ulcerative colitis, eight patients (7.1%) developed the complication of urolithiasis. A higher incidence was found in those with total colitis (15.4%) and in postoperative patients (20%). The mean period between the onset of colitis and the initial urinary symptoms was 5.4 yr. All the analyzed stones contained oxalate and seven of eight patients had hyperoxaluria, which was believed to be one of the important lithogenic factors. Increased urinary Ca/Mg ratio, steroid, and sulfasalazine are suggested as the other lithogenic factors in patients with ulcerative colitis.

Topics: Adult; Calcium; Colitis, Ulcerative; Crystallography; Female; Humans; Magnesium; Male; Middle Aged; Oxalates; Postoperative Complications; Steroids; Sulfasalazine; Urinary Calculi

The incidence of urolithiasis was registered in 87 patients with chronic inflammatory bowel disease and compared with that of renal oxalate excretion. All patients were studied while on a standardized diet with fixed amounts of fat, calcium, and oxalate. Pyelography had been performed in all. Nine, or 35%, of 26 hyperoxaluric patients had urolithiasis, compared with 14, or 23%, of 61 patients were normal renal oxalate excretion, the difference being statistically insignificant. No significant difference in urinary oxalate or urinary calcium in stone-formers as compared with non-stone-formers could be demonstrated. Oxalate was a more frequent component of calculi in patients with normal renal oxalate excretion than in patients with hyperoxalura. Thus, we were unable to demonstrate an increased incidence of urolithiasis in patients with hyperoxaluria compared with a control group with normal renal oxalate excretion. Our results cast doubt on the concept that enteric hyperoxaluria per se is the cause of stone diathesis in chronic inflammatory bowel disease.

Topics: Adult; Calcium; Colitis, Ulcerative; Crohn Disease; Female; Humans; Kidney; Male; Middle Aged; Oxalates; Radiography; Urinary Calculi

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

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

Topics: Adult; Colitis, Ulcerative; Female; Humans; Male; Middle Aged; Oxalates

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

Topics: Adult; Calcium; Colitis, Ulcerative; Creatinine; Crohn Disease; Electrolytes; Female; Humans; Ileum; Magnesium; Male; Oxalates; Prospective Studies; Statistics as Topic; Time Factors; Uric Acid; Urinary Calculi; Urography

Topics: Adrenocorticotropic Hormone; Adult; Calcium; Colitis, Ulcerative; Crohn Disease; Female; Humans; Ileitis; Inflammation; Intestinal Diseases; Kidney Calculi; Male; Oxalates; Proctoscopy; Uric Acid; Urologic Diseases