Intestinal<i>Oxalobacter formigenes</i>Colonization in Calcium Oxalate Stone Formers and Its Relation to Urinary Oxalate

Troxel, Scott; Sidhu, H.; Kaul, P.; Low, Roger K.

doi:10.1089/089277903321618743

Cited by 109 publications

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“…26 Some data suggest that differential rates of colonization by Oxalobacter formigenes, an enteric oxalate-degrading organism, may be responsible for such variation. [27][28][29] Finally, genetic difference between individuals might result in differences in intestinal oxalate absorption. 9 A limitation to this study is that the bioavailability of dietary oxalate may vary substantially by food type.…”

Section: Discussionmentioning

confidence: 99%

Oxalate Intake and the Risk for Nephrolithiasis

Taylor

Curhan

2007

Journal of the American Society of Nephrology

177

116

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Most kidney stones consist of calcium oxalate, and higher urinary oxalate increases the risk for calcium oxalate nephrolithiasis. However, the relation between dietary oxalate and stone risk is unclear. This study prospectively examined the relation between oxalate intake and incident nephrolithiasis in the Health Professionals Follow-up Study (n ϭ 45,985 men), the Nurses' Health Study I (n ϭ 92,872 older women), and the Nurses' Health Study II (n ϭ 101,824 younger women). Food frequency questionnaires were used to assess oxalate intake every 4 yr. Cox proportional hazards regression was used to adjust for age, body mass index, thiazide use, and dietary factors. A total of 4605 incident kidney stones were documented over a combined 44 yr of follow-up. Mean oxalate intakes were 214 mg/d in men, 185 mg/d in older women, and 183 mg/d in younger women and were similar in stone formers and non-stone formers. Spinach accounted for Ͼ40% of oxalate intake. For participants in the highest compared with lowest quintile of dietary oxalate, the relative risks for stones were 1.22 (95% confidence interval [CI] 1.03 to 1.45; P ϭ 0.01 for trend) for men and 1.21 (95% CI 1.01 to 1.44; P ϭ 0.05 for trend) for older women. Risk was higher in men with lower dietary calcium (P ϭ 0.08 for interaction). The relative risks for participants who ate eight or more servings of spinach per month compared with fewer than 1 serving per month were 1.30 (95% CI 1.08 to 1.58) for men and 1.34 (95% CI 1.10 to 1.64) for older women. Oxalate intake and spinach were not associated with risk in younger women. These data do not implicate dietary oxalate as a major risk factor for nephrolithiasis. Kidney stones are common, costly, and painful. The lifetime prevalence of symptomatic nephrolithiasis is approximately 10% in men and 5% in women, 1,2 and more than $2 billion is spent on treatment each year. 3,4 Approximately 80% of kidney stones contain calcium, and the majority of calcium stones consist primarily of calcium oxalate. 5 Small increases in urinary oxalate can have a major effect on calcium oxalate crystal formation, 6 and higher levels of urinary oxalate are a major risk factor for the formation of calcium oxalate kidney stones. 5,7 Because oxalate is a metabolic end product and is excreted unchanged in the urine after absorption in the gastrointestinal tract, clinicians routinely recommend a low-oxalate diet to patients with calcium oxalate nephrolithiasis. 8 However, the role of dietary oxalate in the pathogenesis of calcium oxalate nephrolithiasis is unclear. 9 Uncertainty about the impact of dietary oxalate on stone risk centers around the contribution of oxalate intake to urinary oxalate excretion. A large amount of urinary oxalate is derived from the endogenous metabolism of glycine, glycolate, hydroxyproline, and dietary vitamin C, 10,11 and the proportion of urinary oxalate derived from dietary oxalate is unclear (estimates range from 10 to 50% 12 ). Studies of dietary oxalate and stone risk also must account for the intake...

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Section: Discussionmentioning

confidence: 99%

Oxalate Intake and the Risk for Nephrolithiasis

Taylor

Curhan

2007

Journal of the American Society of Nephrology

177

116

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“…12,14 -16 Little is known about when and how individuals become colonized or the persistence of the bacterium over time, but it seems to be present in a large proportion of the normal adult population, with reported prevalence ranging from 46 to 77%. [17][18][19][20][21][22][23][24][25][26] The bacterium is known to be susceptible to some antibiotics, 27 although the sensitivity pattern is incompletely characterized. The absence of O. formigenes could permit more absorption of dietary oxalate in the colon and decreased secretion from endogenous sources, 28 resulting in higher oxalate excretion in the urine and thus predisposition to CaOx calculus formation.…”

mentioning

confidence: 99%

Oxalobacter formigenes May Reduce the Risk of Calcium Oxalate Kidney Stones

Kaufman

Kelly²,

Curhan³

et al. 2008

Journal of the American Society of Nephrology

258

181

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Most kidney stones are composed primarily of calcium oxalate. Oxalobacter formigenes is a Gramnegative, anaerobic bacterium that metabolizes oxalate in the intestinal tract and is present in a large proportion of the normal adult population. It was hypothesized that the absence of O. formigenes could lead to increased colonic absorption of oxalate, and the subsequent increase in urinary oxalate could favor the development of stones. To test this hypothesis, a case-control study involving 247 adult patients with recurrent calcium oxalate stones and 259 age-, gender-, and region-matched control subjects was performed. The prevalence of O. formigenes, determined by stool culture, was 17% among case patients and 38% among control subjects; on the basis of multivariate analysis controlling demographic factors, dietary oxalate, and antibiotic use, the odds ratio for colonization was 0.3 (95% confidence interval 0.2 to 0.5). The inverse association was consistently present within strata of age, gender, race/ethnicity, region, and antibiotic use. Among the subset of participants who completed a 24-h urine collection, the risk for kidney stones was directly proportional to urinary oxalate, but when urinary factors were included in the multivariable model, the odds ratio for O. formigenes remained 0.3 (95% confidence interval 0.1 to 0.7). Surprisingly, median urinary oxalate excretion did not differ with the presence or absence of O. formigenes colonization. In conclusion, these results suggest that colonization with O. formigenes is associated with a 70% reduction in the risk for being a recurrent calcium oxalate stone former.

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“…No entanto, 9,5% do grupo NE apresentou excreção inadequada. Oxalato urinário é um dos mais importantes fatores litogênicos em pacientes com nefrolitíase por oxalato de cálcio, 29,44 e até mesmo um pequeno aumento na excreção urinária de oxalato pode elevar o risco de cálculos de oxalato de cálcio.…”

Section: Discussionunclassified

Evaluation of food intake and excretion of metabolites in nephrolithiasis

Gordiano¹,

Tondin²,

Miranda³

et al. 2014

Jornal Brasileiro De Nefrologia

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Avaliação da ingestão alimentar e excreção de metabólitos na nefrolitíase Evaluation of food intake and excretion of metabolites in nephrolithiasisIntrodução: A nefrolitíase é uma patologia frequente, com alta taxa de prevalência e recorrência, ocorrendo por processo multifatorial e complexo. Objetivo: Analisar as principais características dietéticas e metabólicas de pacientes com nefrolitíase e compará-los com grupo controle. Métodos: Estudo observacional, transversal, com 31 pacientes com nefrolitíase (NE) e 18 saudáveis. Na ingestão dietética, foram verificados sódio, cálcio, proteína, potássio, vitamina C, oxalato e a ingestão hídrica em ambos os grupos. Na avaliação metabólica, foi analisada excreção urinária de citrato e oxalato. Também foi avaliada presença de hipertensão arterial e Índice de Massa Corporal (IMC). Resultados: Quanto ao grupo NE, verificou-se que 45,2% apresentou alta ingestão de sódio e 100% de oxalato. Foi também observada baixa ingestão de cálcio em 93,5%, potássio em 100% e vitamina C em 94,9%. Com relação à proteína, apenas 12,5% apresentou ingestão normoproteica. Quanto à ingestão hídrica, 12,9% apresentou ingestão menor que 1 litro, 54,8% entre 1 a 2 litros, e 32,3% maior que 2 litros. Foi observada hipertensão arterial sistêmica em 64,5% desses pacientes e excreção adequada de citrato e oxalato em 90,5% deles. Não foi verificada diferença estatística significativa na ingestão alimentar, IMC, e excreção de oxalato entre os grupos. No entanto, o grupo NE apresentou maior excreção de citrato. Conclusão: Verificou-se nos dois grupos elevada prevalência de pacientes com sobrepeso, alta ingestão de oxalato e sódio, além de inadequação nas ingestões de cálcio, potássio e vitamina C. No grupo NE, foi observada alta ingestão proteica e maior excreção de citrato. ResumoPalavras-chave: citratos; ingestão de alimentos; nefrolitíase; oxalato de cálcio. Introduction:Nephrolithiasis is a common condition with high prevalence and recurrence, occuring by a complex and multifactorial process. Objective: To analyze the main dietary and metabolic characteristics of patients with nephrolithiasis and compare them with a control group. Methods: A crosssectional study with 31 patients with nephrolithiasis (NE) and 18 healthy. By the dietary intake it were observed sodium, calcium, protein, potassium, vitamin C, oxalate and water intake in both groups. Metabolic assessment were analyzed in urinary excretion of oxalate and citrate. The presence of hypertension and body mass index (BMI) was also evaluated. Results: In the NE group, it was found that 45.2% had a high intake of sodium and 100% a high intake of oxalate. It was also observed a low calcium, potassium and vitamin C intake by 93.5%, 100% and 94.9% respectively. Regarding protein, only 12.5% had normal protein intake. Concerning water intake, 12.9% had an ingestion less than 1 liter, 54.8% between 1 and 2 liters and 32.3% higher than 2 liters. Hypertension was observed in 64.5% of patients and adequate excretion of oxalate and citrate in 90.5% of t...

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IntestinalOxalobacter formigenesColonization in Calcium Oxalate Stone Formers and Its Relation to Urinary Oxalate

Cited by 109 publications

References 12 publications

Oxalate Intake and the Risk for Nephrolithiasis

Oxalate Intake and the Risk for Nephrolithiasis

Oxalobacter formigenes May Reduce the Risk of Calcium Oxalate Kidney Stones

Evaluation of food intake and excretion of metabolites in nephrolithiasis

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