oxalates and Intestinal-Diseases

Urinary stones are much more common in subjects with intestinal diseases than in the general population. The chemical composition of the stones depends on the type of intestinal disease. In diarrhoeas with loss of water and electrolytes (inflammatory colitis and, chiefly, ileostomy), the urine is acid and concentrated and the stones are composed of uric acid. Extensive lesions of the ileum or wide resections of the small bowel increase the intestinal absorption of oxalates and expose the patients to oxalate stones. Treatment, which must be preventive, is based upon a knowledge of the pathophysiology of urolithiasis.

Topics: Humans; Intestinal Diseases; Oxalates; Uric Acid; Urinary Calculi

Topics: Calcium Oxalate; Cations; Cholestyramine Resin; Diet; Food Analysis; Humans; Intestinal Absorption; Intestinal Diseases; Kidney Calculi; Kidney Diseases; Lipid Metabolism; Malabsorption Syndromes; Oxalates

Oxalosis is the histological manifestation of a number of diverse clinicopathological states involving abnormalities of both endogenous and exogenous oxalate. Crystalline deposits of calcium oxalate, usually first detected by their birefringence, may be characterised by a combination of their physical and tinctorial properties.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Crystallization; Female; Glyoxylates; Hot Temperature; Humans; Infant; Intestinal Diseases; Kidney Diseases; Male; Metabolic Diseases; Metabolism, Inborn Errors; Middle Aged; Oxalates; Solubility; Staining and Labeling

Topics: Calcium; Chemical Phenomena; Chemistry; Crystallization; Humans; Hyperparathyroidism; Intestinal Absorption; Intestinal Diseases; Kidney Tubules; Nephrocalcinosis; Osmolar Concentration; Oxalates

Management of most patients with calculous disease has been less than ideal in the past. Too often therapeutic efforts were limited to symptomatic calculi. Stones were allowed to pass or were removed, metabolic studies were incomplete, victims were dismissed and forgotten, and prophylactic measures were negligible and usually confined to milk restriction and use of distilled water. More patients were crippled with and died of recurrent calculous disease, urinary infection and progressive renal insufficiency than from any other upper urinary tract abnormality. During the last decade the development of a renal stone clinic at this institution has allowed a nephrourologic approach to the management of urolithiasis. This account of classification, diagnosis and management of the various syndromes associated with urolithiasis is based on the experiences gained during the last decade with this common but ill-understood urologic problem.

Topics: Acidosis, Renal Tubular; Adult; Child, Preschool; Cystinuria; Female; Humans; Hypercalcemia; Intestinal Diseases; Kidney Calculi; Male; Middle Aged; Nephrocalcinosis; Oxalates; Sepsis; Uric Acid; Xanthines

Topics: Bile; Bile Acids and Salts; Biological Transport; Biotransformation; Blind Loop Syndrome; Chemical Phenomena; Chemistry, Physical; Cholelithiasis; Cholestasis; Cholesterol; Diarrhea; Enterohepatic Circulation; Humans; Hyperlipidemias; Intestinal Diseases; Lipid Metabolism; Liver Diseases; Metabolism, Inborn Errors; Nephrocalcinosis; Oxalates; Pancreatitis; Stomach Ulcer

Topics: Bile Acids and Salts; Biological Transport; Chemical Phenomena; Chemistry; Cholelithiasis; Cholesterol; Diarrhea; Feces; Humans; Intestinal Diseases; Intestine, Large; Lipid Metabolism; Liver; Malabsorption Syndromes; Metabolic Diseases; Oxalates; Sodium; Water

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: Carbon Radioisotopes; Crohn Disease; Diet Therapy; Glycine; Humans; Ileum; Intestinal Absorption; Intestinal Diseases; Intestinal Mucosa; Mesenteric Vascular Occlusion; Metabolic Diseases; Oxalates

An organic marine hydrocolloid (OMH) charged with calcium ('Ox-Absorb') was studied in vitro for oxalate binding and in patients with enteric hyperoxaluria to investigate oxalate excretion and the inhibitory activity on crystal formation of the urine. In-vitro experiments showed complete binding of oxalate to OMH. In clinical studies in nineteen patients with intestinal disorders and stone formation, urinary oxalate excretion was significantly lower during OMH treatment than off treatment. The activity product index of calcium oxalate was reduced on treatment. A pronounced rise in the inhibitory activity of urine was seen in two patients with very low pretreatment values. Most patients experienced virtual normalisation of bowel function, and in those with severe stone formation there was substantial clinical improvement. It is concluded that OMH has the capacity to bind oxalate in vitro and to reduce urinary oxalate excretion. These observations suggest a new promising treatment for enteric hyperoxaluria.

Topics: Administration, Oral; Adult; Calcium; Clinical Trials as Topic; Colloids; Drug Evaluation; Female; Humans; Hyperoxaluria; Intestinal Absorption; Intestinal Diseases; Intestine, Small; Kidney Calculi; Male; Middle Aged; Oxalates; Pilot Projects; Postoperative Complications; Recurrence; Tablets; Time Factors; Zinc

The diagnostic usefulness of an intestinal oxalic acid absorption test was evaluated in nine patients with ileostomy. They received an oral overload of 250 mg sodium oxalate and 4 Ci oxalic acid-C14 and a controlled diet. The urinary levels of cold and radioactive oxalic acid were measured 24 and 48 hours after the overload. Intestinal oxalic acid absorption in the ileostomized patients was found to be normal, with 16.13 +/- 5.1% of the administered dose being eliminated/recovered in the urine 48 hours after the overload (control value = 14.5 +/- 2.8%). The dose of radioactivity excreted on the second day after the overload was smaller in the ileostomy group than in the control group, possibly connected with the absence of colon. The results suggest that in ileostomized patients whose colon has been removed, oxalic acid absorption is normal. Hence there appears to be no risk of oxalic lithiasis in this group.

Topics: Adult; Aged; Calculi; Humans; Ileostomy; Intestinal Absorption; Intestinal Diseases; Male; Middle Aged; Oxalates; Oxalic Acid; Postoperative Complications

Topics: Adult; Ascorbic Acid; Female; Humans; Intestinal Absorption; Intestinal Diseases; Male; Middle Aged; Oxalates; Urinary Calculi

Kidney stones in patients with inflammatory bowel disease are usually composed of calcium oxalate. Two factors are important in the increased absorption of dietary oxalate which is responsible for those stones: 1) increased absorption of oxalate in the presence of steatorrhea, and 2) increased permeability of the colon to oxalate. Fortunately, some of the physiologic abnormalities can be corrected. A therapeutic approach is detailed.

Topics: Calcium Oxalate; Calcium, Dietary; Colon; Humans; Inflammation; Intestinal Absorption; Intestinal Diseases; Kidney Calculi; Oxalates; Oxalic Acid

Topics: Humans; Intestinal Diseases; Intestine, Small; Oxalates; Urinary Calculi

We describe a sensitive, simple technique for determining urinary oxalate. Urine, diluted as necessary with distilled water, is injected into an ion chromatograph. Oxalate is detected conductimetrically as a distinct peak near the tail of the chromatogram. This peak specifically represents oxalate, because it is abolished if the sample is treated with oxalate decarboxylase. We have used this technique to measure oxalate in more than 3000 consecutively received urine samples. It has a CV of 6%.

Topics: Carbonic Acid; Carboxy-Lyases; Chromatography, Ion Exchange; Humans; Immunoenzyme Techniques; Intestinal Diseases; Kidney Calculi; Oxalates; Spectrophotometry, Atomic

Bile acids and their metabolism play an important role in the pathogenesis of many gastro-intestinal diseases such as gallstone formation, biliary fistula, intestinal congestive symptoms, defective function of the terminal ileum, ulcer pathogenesis. The diagnostics has been improved by enzymatic estimation methods of the bile acids in the serum, functional tests and radioactive marking of the bile acids. Principles of causal surgical therapy as well as internal treatment can be derived from this new pathophysiological knowledge.

Topics: Bile Acids and Salts; Biliary Tract Diseases; Humans; Ileum; Intestinal Diseases; Liver Diseases; Oxalates; Peptic Ulcer; Postoperative Complications; Vagotomy

Topics: Acidosis, Renal Tubular; Aged; Calcium; Calcium, Dietary; Cystinuria; Diet; Humans; Intestinal Diseases; Intestine, Small; Kidney Calculi; Male; Oxalates; Phosphorus; Uric Acid; Urinary Calculi

Intestinal absorption of oxalate was assessed indirectly from the increase in renal oxalate excretion following the oral administration of 5 mmol of stable oxalate. When sodium oxalate alone was given without divalent cations to patients in the fasting state, the urinary oxalate increased promptly (within 2 hours). The increase was more prominent and sustained in those with ileal disease (ileal resection or jujunoileal bypass); thus, 35 per cent of the orally administered oxalate eventually appeared in the urine in the group with ileal disease, 8 per cent in the group with stones (renal and absorptive hypercalciurias) and 9 per cent in the control group. This hyperexcretion of oxalate could be largely, but not totally, ameliorated by the concurrent oral administration of divalent cations. Although urinary oxalate decreased significantly following the oral administration of calcium or magnesium, hyperoxaluria persisted in most patients. The results suggested that the hyperabsorption of oxalate in ileal disease cannot be accounted for solely by an increased absorbable oxalate pool associated with calcium-fatty acid complexation. Moreover, although urinary oxalate decreased, urinary calcium increased concurrently when either calcium or magnesium was given. Thus, there was no significant change or increase in the urinary state of saturation with respect to calcium oxalate.

Topics: Administration, Oral; Calcium; Cations, Divalent; Crystallization; Humans; Ileum; Intestinal Absorption; Intestinal Diseases; Kidney Calculi; Magnesium; Oxalates

Topics: Humans; Ileum; Intestinal Diseases; Kidney Calculi; Oxalates

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

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: Cholestyramine Resin; Humans; Intestinal Diseases; 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

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

Knowledge of the crystalline structure of the calculus provides the basis of the therapeutic plan. Laboratory evaluation depends heavily upon routine urinalysis. Assessment of renal function, serum calcium, phosphorus, uric acid and, in some cases electrolytes is usually indicated, as is urography. General principles of management include maintenance of an ample urine volume, eradication of infection and correction of any obstructing lesions or metabolic abnormalities. Specific antistone regimens are indicated for patients with recurrent urolithiasis.

Topics: Anti-Bacterial Agents; Calcium; Cystinuria; Diarrhea; Female; Humans; Hydrochlorothiazide; Intestinal Diseases; Kidney Calculi; Male; Oxalates; Phosphates; Proteus Infections; Uric Acid; Urinary Calculi

Topics: Bile Acids and Salts; Calcium; Calcium, Dietary; Dietary Fats; Fatty Acids; Humans; Intestinal Absorption; Intestinal Diseases; Intestine, Small; Malabsorption Syndromes; Oleic Acids; Oxalates; Solubility; Taurocholic Acid; Triglycerides

Topics: Animals; Dietary Fats; Humans; Ileum; Intestinal Absorption; Intestinal Diseases; Oxalates

Topics: Bile Acids and Salts; Carbon Dioxide; Carbon Radioisotopes; Cholestyramine Resin; Female; Glycine; Humans; Hydrogen-Ion Concentration; Intestinal Absorption; Intestinal Diseases; Intestine, Small; Intestines; Middle Aged; Oxalates; Postoperative Complications; Syndrome; Urinary Calculi

Topics: Adult; Calcium; Citrates; Crohn Disease; Humans; Intestinal Diseases; Intestine, Small; Male; Middle Aged; Oxalates; Solubility; Urinary Calculi

Topics: Adolescent; Appendix; Calcium; Calculi; Hematuria; Humans; Intestinal Diseases; Intestinal Fistula; Male; Oxalates; Phosphates; Pyuria; Urinary Bladder Fistula; Urography

Topics: Adult; Aged; Bacteria; Bacterial Infections; Bile Acids and Salts; Carbon Isotopes; Crohn Disease; Feces; Female; Glycine; Glycocholic Acid; Humans; Ileum; Intestinal Diseases; Male; Middle Aged; Oxalates; Syndrome

Topics: Humans; Ileum; Intestinal Diseases; Kidney Calculi; Metabolic Diseases; Oxalates; Taurine

Topics: Administration, Oral; Adolescent; Adult; Aged; Bacteria; Bile; Bile Acids and Salts; Carbon Dioxide; Carbon Isotopes; Colon; Glycine; Glyoxylates; Humans; Ileum; Injections, Intravenous; Intestinal Absorption; Intestinal Diseases; Middle Aged; Oxalates; Respiration; Spirometry; Urinary Calculi

Topics: Adult; Aged; Bile Acids and Salts; Cholestyramine Resin; Female; Humans; Ileum; Intestinal Diseases; Kidney Calculi; Male; Metabolic Diseases; Middle Aged; Oxalates; Urography

Topics: Bile Acids and Salts; Carbon Isotopes; Glycine; Glycolates; Humans; Ileum; Intestinal Diseases; Kidney Calculi; Metabolic Diseases; Oxalates

Topics: Bile Acids and Salts; Crohn Disease; Humans; Ileitis; Ileum; Intestinal Absorption; Intestinal Diseases; Oxalates; Taurine

Topics: Adult; Aged; Bacteria; Bile Acids and Salts; Calcium; Colon; Female; Glycine; Glyoxylates; Humans; Ileum; Intestinal Diseases; Kidney Calculi; Male; Middle Aged; Oxalates; Taurine

Topics: Calcium Metabolism Disorders; Glycolates; Humans; Ileum; Intestinal Diseases; Kidney Calculi; Liver; Oxalates; Postoperative Complications; Recurrence; Taurine

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