oxalates and Malabsorption-Syndromes

Enteric hyperoxaluria is commonly observed in malabsorptive conditions including Roux en Y gastric bypass (RYGB) and inflammatory bowel diseases (IBD). Its incidence is increasing secondary to an increased prevalence of both disorders. In this review, we summarize the evidence linking the gut microbiota to the risk of enteric hyperoxaluria.. In enteric hyperoxaluria, fat malabsorption leads to increased binding of calcium to free fatty acids resulting in more soluble oxalate in the intestinal lumen. Bile acids and free fatty acids in the lumen also cause increased gut permeability allowing more passive absorption of oxalate. In recent years, there is more interest in the role of the gut microbiota in modulating urinary oxalate excretion in enteric hyperoxaluria, stemming from our knowledge that microbiota in the intestines can degrade oxalate. Oxalobacter formigenes reduced urinary oxalate in animal models of RYGB. The contribution of other oxalate-degrading organisms and the microbiota community to the pathophysiology of enteric hyperoxaluria are also currently under investigation.. Gut microbiota might play a role in modulating the risk of enteric hyperoxaluria through oxalate degradation and bile acid metabolism. O. formigenes is a promising therapeutic target in this population; however, further studies in humans are needed to test its effectiveness.

Topics: Animals; Anti-Bacterial Agents; Bile Acids and Salts; Gastric Bypass; Gastrointestinal Microbiome; Humans; Hyperoxaluria; Malabsorption Syndromes; Oxalates; Oxalobacter formigenes

Historical studies have demonstrated that the prevalence of symptomatic nephrolithiasis is higher in patients with inflammatory bowel disease (IBD), compared to general population. The aim of the review was to analyze literature data in order to identify the main risk conditions described in literature and the proposed treatment.. A research on the databases PubMed, Medline, Embase and Google Scholar was performed by using the keywords "renal calculi/lithiasis/stones" and "inflammatory bowel diseases". A research on textbooks of reference for Pediatric Nephrology was also performed, with focus on secondary forms of nephrolithiasis.. Historical studies have demonstrated that the prevalence of symptomatic nephrolithiasis is higher in patients with inflammatory bowel disease (IBD), compared to general population, typically in patients who underwent extensive small bowel resection or in those with persistent severe small bowel inflammation. In IBD, kidney stones may arise from chronic inflammation, changes in intestinal absorption due to inflammation, surgery or intestinal malabsorption. Kidney stones are more closely associated with Crohn's Disease (CD) than Ulcerative Colitis (UC) in adult patients for multiple reasons: mainly for malabsorption, but in UC intestinal resection may be an additional risk. Nephrolithiasis is often under-diagnosed and might be a rare but noticeable extra-intestinal presentation of pediatric IBD. Secondary enteric hyperoxaluria the main risk factor of UL in IBD, this has been mainly studied in CD, whether in UC has not been completely explained. In the long course of CD recurrent urolithiasis and calcium-oxalate deposition may cause severe chronic interstitial nephritis and, as a consequence, chronic kidney disease. ESRD and systemic oxalosis often develop early, especially in those patients with multiple bowel resections. Even if we consider that many additional factors are present in IBD as hypomagnesuria, acidosis, hypocitraturia, and others, the secondary hyperoxaluria seems to finally have a central role. Some medications as parenteral vitamin D, long-term and high dose steroid treatment, sulfasalazine are reported as additional risk factors. Hydration status may also play an important role in this process. Intestinal surgery is a widely described independent risk factor. Patients with ileostomy post bowel resection may have relative dehydration from liquid stool, which, added to the acidic pH from bicarbonate loss, is responsible for this process. In this acidic pH, the urinary citrate level excretion reduces. The stones most commonly seen in these patients contain uric acid or are mixed. In addition, the risk of calcium containing stones also increases with ileostomy. The treatment of UL in IBD involves correction of the basic gastrointestinal tract inflammation, restricted dietary oxalate intake, and, at times, increased calcium intake. Citrate therapy that increases both urine pH and urinary citrate could also provide an additional therapeutic benefit. Finally, patients with IBD in a pediatric study had less urologic intervention for their calculosi

Topics: Bicarbonates; Child; Citrates; Dehydration; Disease Susceptibility; Humans; Inflammation; Inflammatory Bowel Diseases; Malabsorption Syndromes; Oxalates; Risk; Urolithiasis

Enteric hyperoxaluria is a common occurrence in the setting of fat malabsorption, usually due to intestinal resection or intestinal bypass surgery. Enhanced intestinal absorption of dietary oxalate leads to elevated renal oxalate excretion, frequently in excess of 100 mg/d (1.14 mmol/d). Patients are at increased risk of urolithiasis and loss of kidney function from oxalate nephropathy. Fat malabsorption causes increased binding of diet calcium by free fatty acids, reducing the calcium available to precipitate diet oxalate. Delivery of unabsorbed bile salts and fatty acids to the colon increases colonic permeability, the site of oxalate hyper-absorption in enteric hyperoxaluria. The combination of soluble oxalate in the intestinal lumen and increased permeability of the colonic mucosa leads to hyperoxaluria. Dietary therapy consists of limiting oxalate and fat intake. The primary medical intervention is the use of oral oxalate binding agents such as calcium salts to reduce free intestinal oxalate levels. Bile acid sequestrants can be useful in patients with ileal resection and bile acid malabsorption. Oxalate degrading bacteria provided as probiotics are being investigated but as of yet, no definite benefit has been shown with currently available preparations. The current state of medical therapy and potential future directions will be summarized in this article.

Topics: Bile Acids and Salts; Diet; Fats; Humans; Hyperoxaluria; Intestinal Absorption; Kidney Calculi; Malabsorption Syndromes; Oxalates; Oxalobacter formigenes

Topics: Ethanol; Exocrine Pancreatic Insufficiency; Humans; Intestinal Absorption; Malabsorption Syndromes; Nutrition Disorders; Nutritional Physiological Phenomena; Oxalates; Pancreas; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis; Triglycerides

Topics: Calcium; Fatty Acids; Humans; Ileal Diseases; Kidney Calculi; Malabsorption Syndromes; Oxalates; Uric Acid

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

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; 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: Acute Kidney Injury; Alcohol Oxidoreductases; Animals; Asia, Southeastern; Calcium; Chemical Phenomena; Chemistry; Female; Glycols; Humans; Hydroxyproline; Infant; L-Lactate Dehydrogenase; Malabsorption Syndromes; Male; Methoxyflurane; Muscles; NAD; Oryza; Oxalates; Thiamine Deficiency; Urinary Calculi; Vitamin B 6 Deficiency

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

Patients with inflammatory bowel disease have a 10- to 100-fold increased risk of nephrolithiasis, with enteric hyperoxaluria being the major risk factor for these and other patients with fat malabsorptive states. Endogenous components of the intestinal microflora can potentially limit dietary oxalate absorption.. Ten patients were studied with chronic fat malabsorption, calcium oxalate stones, and hyperoxaluria thought to be caused by jejunoileal bypass (1) and Roux-en-Y gastric bypass surgery for obesity (4), dumping syndrome secondary to gastrectomy (2), celiac sprue (1), chronic pancreatitis (1), and ulcerative colitis in remission (1). For 3 months, patients received increasing doses of a lactic acid bacteria mixture (Oxadrop), VSL Pharmaceuticals), followed by a washout month. Twenty-four-hour urine collections were performed at baseline and after each month.. Mean urinary oxalate excretion fell by 19% after 1 month (1 dose per day, P < 0.05), and oxalate excretion remained reduced by 24% during the second month (2 doses per day, P < 0.05). During the third month on 3 doses per day oxalate excretion increased slightly, so that the mean was close to the baseline established off treatment. Urinary oxalate again fell 20% from baseline during the washout period. Calcium oxalate supersaturation was reduced while on Oxadrop, largely due to the decrease in oxalate excretion, although mean changes did not reach statistical significance.. Manipulation of gastrointestinal (GI) flora can influence urinary oxalate excretion to reduce urinary supersaturation levels. These changes could have a salutary effect on stone formation rates. Further studies will be needed to establish the optimal dosing regimen.

Topics: Aged; Bifidobacterium; Humans; Hyperoxaluria; Intestines; Kidney Calculi; Lactobacillus acidophilus; Levilactobacillus brevis; Malabsorption Syndromes; Male; Middle Aged; Oxalates; Probiotics; Streptococcus thermophilus; Treatment Outcome

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

Three tests of small intestinal function were performed at 3100 m and 4846 m to seek evidence of malabsorption of high altitude. Xylose tolerance did not change in 11 subjects but, in three who ascended to 5600 m, one-hour xylose levels were significantly lower. The results of an oxalate loading test did not suggest significant fat malabsorption. A direct fat absorption test using chylomicron levels after ingestion of 100 g fat showed significantly increased levels at high altitude. We conclude that there is no evidence of malabsorption up to 4846 m.

Topics: Acetazolamide; Altitude; Chylomicrons; Fats; Humans; Intestinal Absorption; Intestine, Small; Malabsorption Syndromes; Oxalates; Oxalic Acid; Xylose

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

Hyperoxaluria and increased calcium oxalate stone formation occur after Roux-en-Y gastric bypass (RYGB) surgery for morbid obesity. The etiology of this hyperoxaluria is unknown. We hypothesized that after bariatric surgery, intestinal hyperabsorption of oxalate contributes to increases in plasma oxalate and urinary calcium oxalate supersaturation.. We prospectively examined oxalate metabolism in 11 morbidly obese subjects before and 6 and 12 months after RYGB (n = 9) and biliopancreatic diversion-duodenal switch (BPD-DS) (n = 2). We measured 24-hour urinary supersaturations for calcium oxalate, apatite, brushite, uric acid, and sodium urate; fasting plasma oxalate; 72-hour fecal fat; and increases in urine oxalate following an oral oxalate load.. Six and 12 months after RYGB, plasma oxalate and urine calcium oxalate supersaturation increased significantly compared with similar measurements obtained before surgery (all P ≤ .02). Fecal fat excretion at 6 and 12 months was increased (P = .026 and .055, 0 vs 6 and 12 months). An increase in urine oxalate excretion after an oral dose of oxalate was observed at 6 and 12 months (all P ≤ .02). Therefore, after bariatric surgery, increases in fecal fat excretion, urinary oxalate excretion after an oral oxalate load, plasma oxalate, and urinary calcium oxalate supersaturation values were observed.. Enteric hyperoxaluria is often present in patients after the operations of RYGB and BPD-DS that utilize an element of intestinal malabsorption as a mechanism for weight loss.

Topics: Adult; Aged; Calcium Oxalate; Dietary Fats; Female; Follow-Up Studies; Gastric Bypass; Humans; Hyperoxaluria; Intestinal Absorption; Malabsorption Syndromes; Middle Aged; Nephrolithiasis; Obesity, Morbid; Oxalates; Postoperative Complications; Prospective Studies; Risk Factors; Weight Loss

We report a case of a woman with secondary oxalosis after jejunoileal bypass surgery for obesity, who presented with oxalate stone disease and renal insufficiency requiring dialysis. Thirty years after surgery, longstanding osteoarticular symptoms were recognized as oxalate arthritis. Eventually, she also developed oxalate vasculitis, which improved with corticoid treatment and intensification of dialysis. Work-up for kidney transplantation revealed AA amyloidosis on gastric and colonic biopsies. Since no other cause of chronic inflammation could be identified, it was concluded that the amyloidosis was secondary to oxalate arthritis and vasculitis. To our knowledge, this is the first report on this association.

Topics: Amyloidosis; Arthritis; Female; Humans; Hyperoxaluria; Jejunoileal Bypass; Malabsorption Syndromes; Middle Aged; Nephrocalcinosis; Obesity, Morbid; Oxalates; Time Factors; Vasculitis

Hyperoxaluria has been incriminated to account for the increased incidence of urolithiasis or nephrocalcinosis in patients with cystic fibrosis (CF). Hyperoxaluria presumably is caused by fat malabsorption and the absence of such intestinal oxalate-degrading bacteria as Oxalobacter formigenes. To better elucidate its pathophysiological characteristics, we prospectively studied patients with CF by determining these parameters and performing renal ultrasonography twice yearly.. In addition to routine tests in urine (lithogenic and stone-inhibitory substances), the presence of O formigenes was tested in stool, plasma oxalate was measured, and a [13C2]oxalate absorption test was performed in 37 patients with CF aged 5 to 37 years (15 females, 22 males) who were constantly hyperoxaluric before the study.. Hyperoxaluria (oxalate, 46 to 141 mg/1.73 m2/24 h [0.51 to 1.57 mmol/1.73 m2/24 h]; normal, < 45 mg/1.73 m2/24 h [< 0.5 mmol/1.73 m2/24 h]) was now found in 24 patients (64.8%). Plasma oxalate levels were elevated in 6 patients (7.92 to 19.5 micromol/L; normal, 6.3 +/- 1.1 micromol/L). Oxalobacter species were detected in only 1 patient. Intestinal oxalate absorption was elevated (11.4% to 28.5%; normal, < 10%) in 23 patients. Hypocitraturia was present in 17 patients (citrate, 0.35 to 2.8 g/1.73 m2/24 h [0.2 to 1.1 mmol/1.73 m2/24 h]; normal female, > 2.8 mg/1.73 m2/24 h [> 1.6 mmol/1.73 m2/24 h]; male, > 3.3 mg/1.73 m2/24 h [> 1.9 mmol/1.73 m2/24 h]). Urine calcium oxalate saturation was elevated in 17 patients (5.62 to 28.9 relative units; normal female, < 5.5 relative units; male, < 6.3 relative units). In 16% of patients, urolithiasis (n = 2) or nephrocalcinosis (n = 4) was diagnosed ultrasonographically.. Absorptive hyperoxaluria and hypocitraturia are the main culprits for the increased incidence of urolithiasis and nephrocalcinosis in patients with CF. We advocate high fluid intake, low-oxalate/high-calcium diet, and alkali citrate medication, if necessary. Additional studies are necessary to determine the influence of Oxalobacter species or other oxalate-degrading bacteria on oxalate handling in patients with CF.

Topics: Adolescent; Adult; Calcium, Dietary; Carbon Isotopes; Child; Child, Preschool; Citrates; Cystic Fibrosis; Dietary Fats; Feces; Female; Fluid Therapy; Humans; Hyperoxaluria; Intestinal Absorption; Intestines; Malabsorption Syndromes; Male; Nephrocalcinosis; Oxalates; Oxalobacter formigenes; Risk; Urinary Calculi

We report a case of severe nephrocalcinosis related to hypercalcaemia in a newborn with glucose-galactose malabsorption. He presented with poor growth and was noted to have polyuria, which was later recognised to be severe watery diarrhoea. We discuss the possible aetiological factors for nephrocalcinosis in this condition.

Topics: Calcium; Diarrhea; Galactose; Glucose; Growth Disorders; Humans; Hypercalcemia; Infant, Newborn; Karyotyping; Kidney; Malabsorption Syndromes; Male; Nephrocalcinosis; Oxalates; Polyuria; Ultrasonography

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

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

Topics: Child, Preschool; Female; Humans; Hyperoxaluria; Hyperoxaluria, Primary; Infant; Kidney; Kidney Diseases; Malabsorption Syndromes; Male; Oxalates

An investigation of variables important to calcium stone formation in urine indicated significantly increased daily excretion of calcium and oxalate and decreased excretion of ascorbate and citrate by recurrent calcium stone formers. In addition, urine volume, sodium, mucopolysaccharide, and protein were also significantly increased. We compared the uptake of citrate and ascorbate from the gut into the blood in normal controls and stone formers. These studies indicated significantly depressed absorption of both these hydroxycarboxylic acids in recurrent calcium stone formers. We also found that concurrent administration of citrate inhibited ascorbate absorption and increased urinary oxalate excretion after an ascorbate load in normal subjects and stone formers. These findings suggest a mechanism that explains hyperoxaluria in stone patients on the basis of a malabsorption of citrate, ascorbate, and possibly other hydroxycarboxylic acids.

Topics: Absorption; Adult; Ascorbic Acid; Calcium; Citrates; Citric Acid; Female; Humans; Kidney Calculi; Malabsorption Syndromes; Male; Middle Aged; Oxalates; Oxalic Acid; Sodium; Urine

Topics: Adaptation, Physiological; Adolescent; Adult; Aged; Animals; Child; Child, Preschool; Cholelithiasis; Diarrhea; Dogs; Humans; Infant; Infant, Newborn; Long-Term Care; Malabsorption Syndromes; Middle Aged; Oxalates; Parenteral Nutrition; Parenteral Nutrition, Total; Patient Care Team; Short Bowel Syndrome

Oral sodium cellulose phosphate, an inhibitor of intestinal calcium absorption, may reduce urinary magnesium, increase urinary oxalate, and have a limited hypocalciuric action or cause negative calcium balance in the absence of increased calcium absorption or in the presence of renal calcium "leak". To overcome these potential complications, we have taken the following precautions: oral magnesium supplements were given, a moderate oxalate restriction was imposed, a modest dose of sodium cellulose phosphate was used (usually 10 g per day), and only patients with documented absorptive hypercalciuria were treated. During a cumulative treatment period of 42.8 years, 18 patients with recurrent calcium nephrolithiasis showed a sustained reduction in urinary calcium, without developing consistent or substantial reduction in urinary magnesium, hyperoxaluria, hyperparathyroidism, or reduced bone density, Urinary saturation (relative saturation ratio) of calcium oxalate and brushite typically decreased. Remission of stone disease was found in 78 per cent of patients. We conclude that sodium cellulose phosphate is a useful drug for absorptive hypercalciuria when used appropriately.

Topics: Calcium; Cellulose; Female; Humans; Intestinal Absorption; Kidney Calculi; Magnesium; Malabsorption Syndromes; Male; Oxalates

We measured serum and urinary citrate, oxalate, calcium, and magnesium in 22 normal subjects and in 16 patients with malabsorption. The patients had subnormal levels of serum citrate and magnesium during fasting, subnormal 24-hour levels of urinary citrate, magnesium, and calcium, and excessive levels of urinary oxalate. Daily citrate excretion averaged only 15 per cent of normal. The hypocitraturia in the patients resulted from a subnormal filtered load of citrate and abnormally high net tubular reabsorption of the anion. An oral citrate supplement raised both the serum concentration and the filtered load of citrate to normal fasting values, but net tubular reabsorption remained abnormally high and urinary excretion abnormally low. Intramuscular magnesium sulfate, which corrected the hypomagnesemia and hypomagnesuria, had no effect on serum citrate or its filtered load. Nevertheless the injection restored net tubular reabsorption of citrate to normal and partially improved the hypocitraturia. Full correction of the hypocitraturia was achieved by combined treatment with oral citrate and intramuscular magnesium sulfate. Hypocitraturia may contribute to the formation of oxalate stones in these patients, and therefore our treatment may help to prevent this complication.

Topics: Administration, Oral; Adult; Calcium; Citrates; Female; Humans; Injections, Intramuscular; Kidney; Kidney Calculi; Kidney Tubules; Magnesium; Magnesium Sulfate; Malabsorption Syndromes; Male; Middle Aged; Oxalates

The effect of oral calcium on oxalate absorption was studied in eight patients with secondary hyperoxaluria after jejunoileal bypass for morbid obesity during a standardized diet with a fixed supply of fat, calcium, and oxalate. A supplementary calcium dose of 2000 mg/day reduced renal oxalate excretion from 119 to 60 mg/24 h (median values, p < 0.01). Correspondingly, 14C-oxalate absorption decreased from 28% to 9% (p < 0.01). No statistically significant increase in urinary calcium was observed. The study shows that renal oxalate excretion in patients with enteric hyperoxaluria can be reduced by oral calcium. However, we doubt that it has any practical, clinical importance.

Topics: Adolescent; Adult; Calcium; Female; Humans; Ileum; Jejunum; Malabsorption Syndromes; Male; Middle Aged; Obesity; Oxalates; Postoperative Complications

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

143 patients (70 patients with Crohn's disease, 11 with ulcerative colitis, 40 with an intestinal by-pass operation, 9 with non-tropical sprue, 10 with short bowel syndrome, and 3 with other gastrointestinal disease) were studied during a metabolic regime including a fixed oral supply of 70 g fat, 800 mg calcium, and 200 mg oxalate. Faecal fat, 47Ca-absorption, 14C-oxalate absorption, and renal oxalate excretion were measured, and in the majority of patients a 14C-glyco-cholic acid breath test was also performed. 14Ca-absorption was practically identical (r = 0.92), whether determined by whole-body counting or from the accumulation of absorbed 47Ca in the skeleton of the underarm. 14C-oxalate absorption and renal oxalate excretion agreed well (r = 0.85). Steatorrhoea correlated weakly with renal oxalate excretion (r = 0.63, p less than 0.001), whereas no correlation was present between faecal fat and calcium absorption or between oxalate and calcium absorption under the constant conditions prevailing during the study. It is recommended that a "trifixed" regime with absorption studies of fat, calcium, and oxalate be undertaken previous to therapy that aims at a reduction of steatorrhoea or hyperoxaluria or an improvement of calcium absorption in chronic malabsorption syndromes, not least because therapy of these categories of patients most often continues for years.

Topics: Calcium, Dietary; Dietary Fats; Feces; Humans; Malabsorption Syndromes; 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

Topics: Bile Acids and Salts; Child; Cholelithiasis; Cholestasis; Diarrhea; Fats; Gastroenteritis; Humans; Ileum; Infant; Infant, Newborn; Intestinal Absorption; Liver; Liver Circulation; Liver Cirrhosis; Malabsorption Syndromes; Oxalates; Pancreatic Diseases

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

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; Age Factors; Blood Chemical Analysis; Calcium; Child; Citrates; Cystinuria; Diet Therapy; Female; Humans; Hydrochlorothiazide; Hydrogen-Ion Concentration; Kidney Calculi; Malabsorption Syndromes; Male; Medical History Taking; Oxalates; Phosphorus; Racial Groups; Recurrence; Sex Factors; Uric Acid; Urinary Tract Infections; Urine; Urography

Topics: Bile Acids and Salts; Calcium; Crohn Disease; Glycine; Glyoxylates; Humans; Ileum; Intestinal Absorption; Malabsorption Syndromes; Oxalates; Urinary Calculi

Topics: Dietary Fats; Feces; Humans; Malabsorption Syndromes; Oxalates

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

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

Topics: Administration, Oral; Adult; Calcium; Carbon Radioisotopes; Dietary Fats; Fatty Acids; Humans; Ileostomy; Ileum; Intestinal Absorption; Kidney Calculi; Malabsorption Syndromes; Middle Aged; Oxalates