oxalates and Liver-Diseases

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: Bile Acids and Salts; Blind Loop Syndrome; Chenodeoxycholic Acid; Cholelithiasis; Diarrhea; Humans; Ileum; Intestine, Small; Liver Diseases; Liver Function Tests; Oxalates; Oxygen Consumption

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

Patients with primary hyperoxaluria type I (PH I) are prone to develop early kidney failure. Systemic deposition of calcium-oxalate (CaOx) crystals starts, when renal function declines and plasma oxalate increases. All tissue, but especially bone, heart and eyes are affected. However, liver involvement, as CaOx deposition or chronic hepatitis/fibrosis has never been reported. We examined liver specimen from 19 PH I patients (aged 1.5 to 52 years at sample collection), obtained by diagnostic biopsy (1), at autopsy (1), or transplantation (17). With polarization microscopy, birefringent CaOx crystals located in small arteries, but not within hepatocytes were found in 3/19 patients. Cirrhosis was seen in one, fibrosis in 10/19 patients, with porto-portal and nodular fibrosis (n = 1), with limitation to the portal field in 8 and/or to central areas in 5 patients. Unspecific hepatitis features were observed in 7 patients. Fiber proliferations were detectable in 10 cases and in one sample transformed Ito-cells (myofibroblasts) were found. Iron deposition, but also megakaryocytes as sign of extramedullary erythropoiesis were found in 9, or 3 patients, respectively. Overall, liver involvement in patients with PH I was more pronounced, as previously described. However, CaOx deposition was negligible in liver, although the oxalate concentration there must be highest.

Topics: Calcinosis; Calcium; Calcium Oxalate; Fibrosis; Humans; Hyperoxaluria, Primary; Iron; Kidney; Liver Diseases; Oxalates

In PH, PLTX, although ideal in theory, is rarely achieved. Patients usually have reached end-stage kidney disease while requiring combined liver and kidney transplantation. In this combined procedure, the sudden high oxalates mobilization from blood and tissue stores jeopardizes the success of the kidney graft, with a high risk of post-transplant early kidney necrosis or chronic graft damage. Here, we report the case of a three-yr-old girl with PH and ESRF in whom we performed sequentially deceased donor liver transplantation followed four months later by living donor kidney transplant, after normalization of blood oxalate levels and improvement of urinary oxalate output. After this two-step transplantation, our patient showed normalization of renal function with good urinary output and maintained normal blood oxalate levels. This strategy seems to be a reasonable approach in order to avoid acute renal tubular injury because of oxalate excretion in these patients.

Topics: Cadaver; Child, Preschool; Female; Graft Survival; Humans; Hyperoxaluria, Primary; Kidney Diseases; Kidney Transplantation; Liver Diseases; Liver Transplantation; Oxalates; Risk; Treatment Outcome

The current work was designed to study the potential of N-acetylcysteine (NAC) in modulating hyperoxaluric manifestations induced by acute oxalate dose in rat liver. Hyperoxaluric conditions were induced by giving a single dose of sodium oxalate (70 mg/kg body weight) in one group, and in the other group, hyperoxaluric rats were administered NAC (200 mg/kg body weight) after 30 min of the oxalate dose. After 12 h of the above treatment, blood was taken from the orbital sinus for testing serum oxalate, and animals were sacrificed. To exploit the potential of NAC, various oxidative stress parameters [lipid peroxidation (LP) and activity of antioxidant enzymes], lipid content, and histologic analysis of rat liver were performed. The increased level of LP and activities of superoxide dismutase and catalase in hyperoxaluric rats were restored after NAC treatment. Not only the decreased amount of total lipids and phospholipids but also the increased ratio of cholesterol/phospholipid (showing decreased membrane fluidity) in hyperoxaluric rats were balanced by NAC treatment. Further restored histologic changes of liver tissue confirmed the protective antioxidant effects of the given drug. Thus, N-acetylcysteine being an extraneous antioxidant showed curative properties toward hyperoxaluric manifestations in liver.

Topics: Acetylcysteine; Animals; Catalase; Disease Models, Animal; Free Radical Scavengers; Hyperoxaluria; Lipid Metabolism; Lipid Peroxidation; Liver; Liver Diseases; Male; Membrane Fluidity; Oxalates; Oxidative Stress; Rats; Rats, Wistar; Superoxide Dismutase

One hundred and sixty three children who received total parenteral nutrition (TPN), including 7 cases of short bowel syndrome, were studied to evaluate the role of TPN in the management of infants with extremely short bowel. Three of the seven were died of sepsis related with central venous catheter (CV catheter) during the period of malabsorption when TPN was necessary. Two children of other diseases were died of catheter sepsis, 5 out of 163 in total, making the mortality late of TPN 3%. Incidence of CV catheter related complications was significantly less frequent in Broviac catheter when compared with conventional Silastic catheter (p less than 0.01). Another significant complication of TPN in cases of short bowel syndrome was hepatic dysfunction. Cholestatic liver dysfunction seemed to be cleared when enteral feeding was started even with TPN going on. Oral feeding should be started in the early postoperative period with concomitant TPN covering the fluid loss. A case of copper deficiency with high output jejunostomy and a case of urolithiasis with hyperoxaluria complicated with short bowel were reported.

Topics: Catheterization; Child; Child, Preschool; Follow-Up Studies; Humans; Liver Diseases; Malabsorption Syndromes; Oxalates; Parenteral Nutrition, Total; Short Bowel Syndrome

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

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

During the last years bile acids have gained more and more clinical importance. They play a decisive part in intestinal fat resorption. Increased bile acid content in the colon will result in diarrhea. By determination of serum bile acids the liver function can be judged exactly. It seems probable that bile acids take part in the pathogenesis of gastritis gastric ulcer and colonic cancer. By administration of chenodeoxycholic acid and ursodeoxycholic acid dissolution of cholesterol stones within the gall bladder is possible.

Topics: Bile Acids and Salts; Chenodeoxycholic Acid; Cholelithiasis; Colonic Neoplasms; Deoxycholic Acid; Gastritis; Humans; Intestinal Absorption; Liver Diseases; Oxalates; Stomach Ulcer

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

Intestinal bypass for obesity can be justified only if the risks of excess weight are higher than those of the surgery. Indications for this surgery need to be carefully defined and the patient and family should clearly understand the potential risks and benefits. Weight loss results from a decrease in food intake, altered taste preferences, and malabsorption. The benefits of this treatment are permanent weight loss, improved psychosocial function, and a reduction in medical morbidity. The potential risks consist of mortality, a variety of postoperative complications, liver failure, renal stones, and the consequences of bacterial overgrowth in the defunctionalized bowel. This operation trades the consequences of a short bowel for obesity and should only be undertaken where a skilled team of surgeons, internists, and psychiatrists are available and able to provide the necessary preoperative and postoperative managements.

Topics: Body Weight; Feeding Behavior; Female; Humans; Ileum; Intestinal Absorption; Intestines; Jejunum; Kidney Calculi; Liver Diseases; Male; Nutrition Disorders; Obesity; Oxalates; Postoperative Complications; Psychology, Social

A review of the problems associated with extensive jejunoileal bypass for morbid obesity in a series of 175 carefully selected patients is presented. Five postoperative deaths occurred (3%). Nonfatal complications occurred in 21%, with wound infections (14 patients) being the most common. Good results marked by weight reduction to the range of ideal weight without significant electrolyte or metabolic aberrations was observed in 82% of the patients receiving the current dimensional modificatiom of end-to-end jejunoileal bypass (30 cm to 20cm). An additional 13% had fair results and only 5% had poor results. There were six deaths during follow-up: liver failure in four patients (secondary to alcohol abuse in two), myocardial infarction in one, and one from unknown causes. Bypass reversal was necessary for refractory liver failure in three patients (two from alcohol abuse), and for persistent diarrhea with secondary electrolyte depletion in two patients. One of these patients was complicated by severe emotional instability. This experience suggests that the majority of carefully selected patients will have a good response to jejunoileal bypass.

Topics: Adolescent; Adult; Anemia; Avitaminosis; Body Weight; Cholelithiasis; Diarrhea; Electrolytes; Fatty Liver; Female; Follow-Up Studies; Gout; Humans; Hypoproteinemia; Ileum; Jejunum; Kidney Calculi; Liver Diseases; Male; Middle Aged; Obesity; Oxalates; Postoperative Complications

Initially, diarrhea is almost universal but becomes self-limited unless the patient persists in overeating. Weight loss averages 75 to 100 lb the first year, with a stable level generally achieved after 18 months. Among the serious potential complications are enteritis, kidney stones, gallstones, and hepatopathology. Some can be anticipated and kept at bay by prophylactic measures like high-protein intake.

Topics: Anti-Bacterial Agents; Arthritis; Body Temperature Regulation; Cholelithiasis; Dermatitis; Diarrhea; Dietary Proteins; Enteritis; Fatty Liver; Humans; Ileum; Intestinal Absorption; Kidney Calculi; Liver Diseases; Obesity; Oxalates; Postoperative Complications

A perfusion technique has been used to study the effect of sodium chenodeoxycholate (5 mmol 1-1) on absorption of oxalate (2 mmol 1-1) from the surgically excluded colon in two patients with chronic liver disease. Colonic absorption of oxalate increased at least fivefold when sodium chenodeoxycholate was incorporated in the perfusion solutions. This observation may explain enteric hyperoxaluria after ileal resection and in some other gastrointestinal disorders.

Topics: Adult; Aged; Chenodeoxycholic Acid; Chronic Disease; Colon; Humans; Intestinal Absorption; Liver Diseases; Oxalates; Perfusion; Time Factors; Water

A patient with liver dysfunction following small-bowel bypass for obesity was treated successfully with intravenous hyperalimentation. The hepatic steatosis and dysfunction were most likely caused by the preferential absorption of carbohydrate in the remaining small bowel, with resulting relative protein starvation. Routine use of high-protein, low-carbohydrate diets postoperatively until weight stabilization has occurred may prevent this complication.

Topics: Adult; Biopsy; Body Weight; Dietary Carbohydrates; Dietary Proteins; Fatty Liver; Humans; Ileum; Jejunum; Liver; Liver Diseases; Male; Obesity; Oxalates; Parenteral Nutrition; Parenteral Nutrition, Total; Postoperative Complications; Protein-Energy Malnutrition

Topics: Adolescent; Adult; Anemia, Hypochromic; Avitaminosis; Cholelithiasis; Diarrhea; Female; Follow-Up Studies; Gout; Humans; Ileum; Jejunum; Kidney Calculi; Liver Diseases; Male; Middle Aged; Obesity; Oxalates; Postoperative Complications

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

Topics: Child; Humans; Intestine, Small; Kidney Calculi; Liver Diseases; Malabsorption Syndromes; Oxalates

Topics: Animals; Cattle; Cattle Diseases; Female; Fetal Diseases; Kidney Diseases; Liver Diseases; Metabolic Diseases; Oxalates; Pregnancy

Topics: Gastrointestinal Diseases; Humans; Liver Diseases; Malabsorption Syndromes; Oxalates

Topics: Calcium; Cholelithiasis; Humans; Kidney Calculi; Liver Diseases; Oxalates; Tyramine

Topics: Ascorbic Acid; Bilirubin; Humans; Liver Diseases; Male; Oxalates; Self Medication

Topics: Animals; Kidney Diseases; Liver Diseases; Oxalates; Proteinuria; Swine; Swine Diseases; Urea

Topics: Adult; Aged; Atrophy; Cholelithiasis; Clinical Enzyme Tests; Diagnosis, Differential; Female; Hepatitis A; Humans; Isoenzymes; L-Lactate Dehydrogenase; Liver; Liver Cirrhosis; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Oxalates; Potassium; Urea

Topics: Adrenal Cortex Hormones; Adult; Calcium; Diagnosis, Differential; Humans; Hypercalcemia; Hyperparathyroidism; Kidney Calculi; Liver Diseases; Lung Diseases; Male; Oxalates; Radiography; Sarcoidosis

Topics: Calcium; Calcium Oxalate; Cell Biology; Chemistry Techniques, Analytical; Crystallography; Electrons; Humans; Kidney; Kidney Diseases; Kidney Tubules; Liver Diseases; Microscopy; Microscopy, Electron; Neoplasms; Oxalates; X-Ray Diffraction

Topics: Biliary Dyskinesia; Cholecystectomy; Gallbladder Diseases; Gastrointestinal Diseases; Humans; Liver Diseases; Oxalates; Pancreatitis; Urinary Calculi

Topics: Alanine Transaminase; Clinical Enzyme Tests; D-Alanine Transaminase; Humans; Isocitrate Dehydrogenase; Liver Diseases; Metabolism; Myocardial Infarction; Oxalates; Oxidoreductases

Topics: Hepatitis; Hepatitis, Chronic; Humans; Hyperoxaluria; Liver Diseases; Oxalates; Urinary Calculi