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Erschienen in: Pediatric Nephrology 7/2012

01.07.2012 | Original Article

Enteric hyperoxaluria, recurrent urolithiasis, and systemic oxalosis in patients with Crohn’s disease

Erschienen in: Pediatric Nephrology | Ausgabe 7/2012

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Abstract

Background

Prevalence of recurrent calcium-oxalate (CaOx) urolithiasis (UL) is up to fivefold higher in Crohn’s disease than in the general population. Treatment options are scarce and the risk of recurrent UL or progressive renal CaOx deposition, (oxalosis) based early end-stage renal failure (ESRF), subsequent systemic oxalosis, and recurrence in the kidney graft is pronounced. We aimed to find proof that secondary hyperoxaluria is the main risk factor for the devastating course and correlates with intestinal oxalate absorption.

Methods

24-h urines were collected and analyzed for urinary oxalate (Uox) in 27 pediatric (6–18 years) and 19 adult patients (20–62 years). In the 21 patients (8 adults and 13 children) with hyperoxaluria a [13C2]oxalate absorption test was performed under standardized dietary conditions.

Results

Mean Uox was significantly higher in patients with UL or oxalosis (0.92 ± 0.57) compared with those without (0.53 ± 0.13 mmol/1.73 m2/24 h, p<0.05, normal < 0.5). Hyperoxaluria then significantly correlated with intestinal oxalate absorption (p< 0.05).

Conclusion

As UL/oxalosis has major implications for the general health in patients with Crohn’s disease (ESRF and systemic oxalosis), new medication, e.g. to reduce intestinal oxalate absorption, is definitely needed.
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Literatur
1.
Zurück zum Zitat VanDervoort K, Wiesen J, Frank R, Vento S, Crosby V, Chandra M, Trachtman H (2007) Urolithiasis in pediatric patients: a single center study of incidence, clinical presentation and outcome. J Urol 177:2300–2305PubMedCrossRef VanDervoort K, Wiesen J, Frank R, Vento S, Crosby V, Chandra M, Trachtman H (2007) Urolithiasis in pediatric patients: a single center study of incidence, clinical presentation and outcome. J Urol 177:2300–2305PubMedCrossRef
2.
Zurück zum Zitat Sas DJ, Hulsey TC, Shatat IF, Orak JK (2010) Increasing incidence of kidney stones in children evaluated in the emergency department. J Pediatr 157:132–137PubMedCrossRef Sas DJ, Hulsey TC, Shatat IF, Orak JK (2010) Increasing incidence of kidney stones in children evaluated in the emergency department. J Pediatr 157:132–137PubMedCrossRef
3.
Zurück zum Zitat Andersson H, Bosaeus I, Fasth S, Hellberg R, Hulten L (1987) Cholelithiasis and urolithiasis in Crohn's disease. Scand J Gastroenterol 22:253–256PubMedCrossRef Andersson H, Bosaeus I, Fasth S, Hellberg R, Hulten L (1987) Cholelithiasis and urolithiasis in Crohn's disease. Scand J Gastroenterol 22:253–256PubMedCrossRef
4.
Zurück zum Zitat Hoppe B, Leumann E, von Unruh G, Laube N, Hesse A (2003) Diagnostic and therapeutic approaches in patients with secondary hyperoxaluria. Front Biosci 8:e437–e443PubMedCrossRef Hoppe B, Leumann E, von Unruh G, Laube N, Hesse A (2003) Diagnostic and therapeutic approaches in patients with secondary hyperoxaluria. Front Biosci 8:e437–e443PubMedCrossRef
5.
Zurück zum Zitat Neuhaus TJ, Belzer T, Blau N, Hoppe B, Sidhu H, Leumann E (2000) Urinary oxalate excretion in urolithiasis and nephrocalcinosis. Arch Dis Child 82:322–326PubMedCrossRef Neuhaus TJ, Belzer T, Blau N, Hoppe B, Sidhu H, Leumann E (2000) Urinary oxalate excretion in urolithiasis and nephrocalcinosis. Arch Dis Child 82:322–326PubMedCrossRef
6.
Zurück zum Zitat Holmes RP, Goodman HO, Assimos DG (2001) Contribution of dietary oxalate to urinary oxalate excretion. Kidney Int 59:270–276PubMedCrossRef Holmes RP, Goodman HO, Assimos DG (2001) Contribution of dietary oxalate to urinary oxalate excretion. Kidney Int 59:270–276PubMedCrossRef
7.
Zurück zum Zitat Williams HE, Wandzilak TR (1989) Oxalate synthesis, transport and the hyperoxaluric syndromes. J Urol 141:742–749PubMed Williams HE, Wandzilak TR (1989) Oxalate synthesis, transport and the hyperoxaluric syndromes. J Urol 141:742–749PubMed
8.
Zurück zum Zitat Leumann E, Hoppe B (2001) The primary hyperoxalurias. J Am Soc Nephrol 12:1986–1993PubMed Leumann E, Hoppe B (2001) The primary hyperoxalurias. J Am Soc Nephrol 12:1986–1993PubMed
9.
Zurück zum Zitat Binder HJ (1974) Intestinal oxalate absorption. Gastroenterology 67:441–446PubMed Binder HJ (1974) Intestinal oxalate absorption. Gastroenterology 67:441–446PubMed
10.
Zurück zum Zitat Dobbins JW, Binder HJ (1976) Effect of bile salts and fatty acids on the colonic absorption of oxalate. Gastroenterology 70:1096–1100PubMed Dobbins JW, Binder HJ (1976) Effect of bile salts and fatty acids on the colonic absorption of oxalate. Gastroenterology 70:1096–1100PubMed
11.
Zurück zum Zitat Chadwick VS, Modha K, Dowling RH (1973) Mechanism for hyperoxaluria in patients with ileal dysfunction. N Engl J Med 289:172–176PubMedCrossRef Chadwick VS, Modha K, Dowling RH (1973) Mechanism for hyperoxaluria in patients with ileal dysfunction. N Engl J Med 289:172–176PubMedCrossRef
12.
Zurück zum Zitat Booth CC, Babouris N, Hanna S, Macintyre I (1963) Incidence of hypomagnesaemia in intestinal malabsorption. Br Med J 2:141–144PubMedCrossRef Booth CC, Babouris N, Hanna S, Macintyre I (1963) Incidence of hypomagnesaemia in intestinal malabsorption. Br Med J 2:141–144PubMedCrossRef
13.
Zurück zum Zitat Trinchieri A, Lizzano R, Castelnuovo C, Zanetti G, Pisani E (2002) Urinary patterns of patients with renal stones associated with chronic inflammatory bowel disease. Arch Ital Urol Androl 74:61–64PubMed Trinchieri A, Lizzano R, Castelnuovo C, Zanetti G, Pisani E (2002) Urinary patterns of patients with renal stones associated with chronic inflammatory bowel disease. Arch Ital Urol Androl 74:61–64PubMed
14.
Zurück zum Zitat Rudman D, Dedonis JL, Fountain MT, Chandler JB, Gerron GG, Fleming GA, Kutner MH (1980) Hypocitraturia in patients with gastrointestinal malabsorption. N Engl J Med 303:657–661PubMedCrossRef Rudman D, Dedonis JL, Fountain MT, Chandler JB, Gerron GG, Fleming GA, Kutner MH (1980) Hypocitraturia in patients with gastrointestinal malabsorption. N Engl J Med 303:657–661PubMedCrossRef
15.
16.
Zurück zum Zitat Caudarella R, Rizzoli E, Pironi L, Malavolta N, Martelli G, Poggioli G, Gozzetti G, Miglioli M (1993) Renal stone formation in patients with inflammatory bowel disease. Scanning Microsc 7:371–379, discussion 379-380PubMed Caudarella R, Rizzoli E, Pironi L, Malavolta N, Martelli G, Poggioli G, Gozzetti G, Miglioli M (1993) Renal stone formation in patients with inflammatory bowel disease. Scanning Microsc 7:371–379, discussion 379-380PubMed
17.
Zurück zum Zitat Hylander E, Jarnum S, Frandsen I (1979) Urolithiasis and hyperoxaluria in chronic inflammatory bowel disease. Scand J Gastroenterol 14:475–479PubMed Hylander E, Jarnum S, Frandsen I (1979) Urolithiasis and hyperoxaluria in chronic inflammatory bowel disease. Scand J Gastroenterol 14:475–479PubMed
19.
Zurück zum Zitat Beck B, Habbig S, Feldkötter M, Wolf M, Bangen U, Michalk D, Stapenhorst L, Burst V, Stippel D, Fries J, Hoppe B (2008) How to handle the dilemma of ESRF and systemic oxalosis in short bowel syndrome from Crohn's disease - a potential application for Oxalobacter formigenes. Pediatr Nephrol 23:P065 Beck B, Habbig S, Feldkötter M, Wolf M, Bangen U, Michalk D, Stapenhorst L, Burst V, Stippel D, Fries J, Hoppe B (2008) How to handle the dilemma of ESRF and systemic oxalosis in short bowel syndrome from Crohn's disease - a potential application for Oxalobacter formigenes. Pediatr Nephrol 23:P065
20.
Zurück zum Zitat Dick PT, Shuckett BM, Tang B, Daneman A, Kooh SW (1999) Observer reliability in grading nephrocalcinosis on ultrasound examinations in children. Pediatr Radiol 29:68–72PubMedCrossRef Dick PT, Shuckett BM, Tang B, Daneman A, Kooh SW (1999) Observer reliability in grading nephrocalcinosis on ultrasound examinations in children. Pediatr Radiol 29:68–72PubMedCrossRef
21.
Zurück zum Zitat Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–263PubMed Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–263PubMed
22.
Zurück zum Zitat Sikora P, von Unruh GE, Beck B, Feldkotter M, Zajaczkowska M, Hesse A, Hoppe B (2008) [13C2]oxalate absorption in children with idiopathic calcium oxalate urolithiasis or primary hyperoxaluria. Kidney Int 73:1181–1186PubMedCrossRef Sikora P, von Unruh GE, Beck B, Feldkotter M, Zajaczkowska M, Hesse A, Hoppe B (2008) [13C2]oxalate absorption in children with idiopathic calcium oxalate urolithiasis or primary hyperoxaluria. Kidney Int 73:1181–1186PubMedCrossRef
23.
Zurück zum Zitat von Unruh GE, Langer MA, Paar DW, Hesse A (1998) Mass spectrometric-selected ion monitoring assay for an oxalate absorption test applying [13C2]oxalate. J Chromatogr B: Biomed Sci Appl 716:343–349CrossRef von Unruh GE, Langer MA, Paar DW, Hesse A (1998) Mass spectrometric-selected ion monitoring assay for an oxalate absorption test applying [13C2]oxalate. J Chromatogr B: Biomed Sci Appl 716:343–349CrossRef
24.
Zurück zum Zitat Hoppe B, Jahnen A, Bach D, Hesse A (1997) Urinary calcium oxalate saturation in healthy infants and children. J Urol 158:557–559PubMedCrossRef Hoppe B, Jahnen A, Bach D, Hesse A (1997) Urinary calcium oxalate saturation in healthy infants and children. J Urol 158:557–559PubMedCrossRef
25.
Zurück zum Zitat Hylander E, Jarnum S, Jensen HJ, Thale M (1978) Enteric hyperoxaluria: dependence on small intestinal resection, colectomy, and steatorrhoea in chronic inflammatory bowel disease. Scand J Gastroenterol 13:577–588PubMedCrossRef Hylander E, Jarnum S, Jensen HJ, Thale M (1978) Enteric hyperoxaluria: dependence on small intestinal resection, colectomy, and steatorrhoea in chronic inflammatory bowel disease. Scand J Gastroenterol 13:577–588PubMedCrossRef
26.
Zurück zum Zitat Hesse A, Schneeberger W, Engfeld S, Von Unruh GE, Sauerbruch T (1999) Intestinal hyperabsorption of oxalate in calcium oxalate stone formers: application of a new test with [13C2]oxalate. J Am Soc Nephrol 10 [Suppl 14]:S329–S333PubMed Hesse A, Schneeberger W, Engfeld S, Von Unruh GE, Sauerbruch T (1999) Intestinal hyperabsorption of oxalate in calcium oxalate stone formers: application of a new test with [13C2]oxalate. J Am Soc Nephrol 10 [Suppl 14]:S329–S333PubMed
27.
Zurück zum Zitat Asplin JR (2002) Hyperoxaluric calcium nephrolithiasis. Endocrinol Metab Clin North Am 31:927–949PubMedCrossRef Asplin JR (2002) Hyperoxaluric calcium nephrolithiasis. Endocrinol Metab Clin North Am 31:927–949PubMedCrossRef
28.
Zurück zum Zitat Sikora P, Zajaczkowska M, Hoppe B (2009) Assessment of crystallization risk formulas in pediatric calcium stone-formers. Pediatr Nephrol 24:1997–2003PubMedCrossRef Sikora P, Zajaczkowska M, Hoppe B (2009) Assessment of crystallization risk formulas in pediatric calcium stone-formers. Pediatr Nephrol 24:1997–2003PubMedCrossRef
29.
Zurück zum Zitat Laube N, Hoppe B, Hesse A (2005) Problems in the investigation of urine from patients suffering from primary hyperoxaluria type 1. Urol Res 33:394–397PubMedCrossRef Laube N, Hoppe B, Hesse A (2005) Problems in the investigation of urine from patients suffering from primary hyperoxaluria type 1. Urol Res 33:394–397PubMedCrossRef
30.
Zurück zum Zitat von Unruh GE, Voss S, Sauerbruch T, Hesse A (2003) Reference range for gastrointestinal oxalate absorption measured with a standardized [13C2]oxalate absorption test. J Urol 169:687–690CrossRef von Unruh GE, Voss S, Sauerbruch T, Hesse A (2003) Reference range for gastrointestinal oxalate absorption measured with a standardized [13C2]oxalate absorption test. J Urol 169:687–690CrossRef
31.
Zurück zum Zitat el-Habet AE, el-Sewedy SM, el-Sharaky A, Gaafar NK, Abdel-Rafee A, Hamoud F (1987) Biochemical studies on bilharzial and nonbilharzial hyperoxaluria: effect of pyridoxine and allopurinol treatment. Biochem Med Metab Biol 38:1–8PubMedCrossRef el-Habet AE, el-Sewedy SM, el-Sharaky A, Gaafar NK, Abdel-Rafee A, Hamoud F (1987) Biochemical studies on bilharzial and nonbilharzial hyperoxaluria: effect of pyridoxine and allopurinol treatment. Biochem Med Metab Biol 38:1–8PubMedCrossRef
32.
Zurück zum Zitat Zimmermann DJ, Hesse A, von Unruh GE (2005) Influence of a high-oxalate diet on intestinal oxalate absorption. World J Urol 23:324–329PubMedCrossRef Zimmermann DJ, Hesse A, von Unruh GE (2005) Influence of a high-oxalate diet on intestinal oxalate absorption. World J Urol 23:324–329PubMedCrossRef
33.
Zurück zum Zitat Sidhu H, Schmidt ME, Cornelius JG, Thamilselvan S, Khan SR, Hesse A, Peck AB (1999) Direct correlation between hyperoxaluria/oxalate stone disease and the absence of the gastrointestinal tract-dwelling bacterium Oxalobacter formigenes: possible prevention by gut recolonization or enzyme replacement therapy. J Am Soc Nephrol 10 [Suppl 14]:S334–S340PubMed Sidhu H, Schmidt ME, Cornelius JG, Thamilselvan S, Khan SR, Hesse A, Peck AB (1999) Direct correlation between hyperoxaluria/oxalate stone disease and the absence of the gastrointestinal tract-dwelling bacterium Oxalobacter formigenes: possible prevention by gut recolonization or enzyme replacement therapy. J Am Soc Nephrol 10 [Suppl 14]:S334–S340PubMed
34.
Zurück zum Zitat Kumar R, Mukherjee M, Bhandari M, Kumar A, Sidhu H, Mittal RD (2002) Role of Oxalobacter formigenes in calcium oxalate stone disease: a study from North India. Eur Urol 41:318–322PubMedCrossRef Kumar R, Mukherjee M, Bhandari M, Kumar A, Sidhu H, Mittal RD (2002) Role of Oxalobacter formigenes in calcium oxalate stone disease: a study from North India. Eur Urol 41:318–322PubMedCrossRef
35.
Zurück zum Zitat Duncan SH, Richardson AJ, Kaul P, Holmes RP, Allison MJ, Stewart CS (2002) Oxalobacter formigenes and its potential role in human health. Appl Environ Microbiol 68:3841–3847PubMedCrossRef Duncan SH, Richardson AJ, Kaul P, Holmes RP, Allison MJ, Stewart CS (2002) Oxalobacter formigenes and its potential role in human health. Appl Environ Microbiol 68:3841–3847PubMedCrossRef
36.
Zurück zum Zitat Hoppe B, Beck B, Gatter N, von Unruh G, Tischer A, Hesse A, Laube N, Kaul P, Sidhu H (2006) Oxalobacter formigenes: a potential tool for the treatment of primary hyperoxaluria type 1. Kidney Int 70:1305–1311PubMedCrossRef Hoppe B, Beck B, Gatter N, von Unruh G, Tischer A, Hesse A, Laube N, Kaul P, Sidhu H (2006) Oxalobacter formigenes: a potential tool for the treatment of primary hyperoxaluria type 1. Kidney Int 70:1305–1311PubMedCrossRef
Metadaten
Titel
Enteric hyperoxaluria, recurrent urolithiasis, and systemic oxalosis in patients with Crohn’s disease
Publikationsdatum
01.07.2012
Erschienen in
Pediatric Nephrology / Ausgabe 7/2012
Print ISSN: 0931-041X
Elektronische ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-012-2126-8

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