Outpatient Antibiotic Use is Not Associated with an Increased Risk of First-Time Symptomatic Kidney Stones

Lifestyle Factors and the Microbiome in Urolithiasis: A Narrative Review

Urolithiasis represents one of the most common urologic diseases, and its incidence demonstrates, globally, an increasing trend. The application of preventive measures is an established strategy to reduce urolithiasis-related morbidity, and it is based mostly on the adaptation of lifestyle factors and pharmacotherapy. Furthermore, other research areas demonstrate promising results, such as the research on the microbiome. In the current review, we searched for the latest data on lifestyle-based prevention and microbiome alterations in urolithiasis patients. The majority of the proposed lifestyle measures are already included in the urological guidelines, while additional factors, such as vitamin D supplementation, seem to have a putative positive effect. From the microbiome studies, several microbial composition patterns and metabolic pathways demonstrated an inhibiting or promoting role in lithogenesis. Up to the present, stone prevention has not shown satisfying results, which suggests that lifestyle measures are not adequate. Moreover, microbiome studies are prone to bias, since microbes are strongly affected by numerous clinical factors, while the analysis procedures are not standardized yet. Analysis standardization and data pooling from extensive registration of clinical and microbiome data are essential steps in order to improve the existing prevention strategy with targeted microbiome manipulations.

Mechanism of Nephrolithiasis: Does the Microbiome Play a Role?

Nephrolithiasis imposes a significant health care burden around the world. In the past decade, there has been considerable interest in the human microbiota in relation to the onset of nephrolithiasis. Most of the research has focused on degradation of oxalate, a known causative factor for nephrolithiasis, by bacteria in the gut. More recently, the role of antibiotic exposure and changes to short-chain fatty acids have been investigated. Studies have revealed that the urinary tract, previously thought to be sterile, harbors resident microbial communities closely associated with nephrolithiasis. In this mini-review, we evaluate potential causative roles of the microbiome in the onset of nephrolithiasis and the development of novel therapies to prevent this disease. PATIENT SUMMARY: This mini-review discusses scientific evidence on the influence of bacteria in our intestines and urinary tract on the formation of kidney stones. We discuss possible therapies targeting these bacteria that could prevent kidney stones from forming.

Pathophysiology and management of enteric hyperoxaluria

Enteric hyperoxaluria is a metabolic disorder resulting from conditions associated with fatty acid malabsorption and characterized by an increased urinary output of oxalate. Oxalate is excessively absorbed in the gut and then excreted in urine where it forms calcium oxalate crystals, inducing kidney stones formation and crystalline nephropathies. Enteric hyperoxaluria is probably underdiagnosed and may silently damage kidney function of patients affected by bowel diseases. Moreover, the prevalence of enteric hyperoxaluria has increased because of the development of bariatric surgical procedures. Therapeutic options are based on the treatment of the underlying disease, limitation of oxalate intakes, increase in calcium salts intakes but also increase in urine volume and correction of hypocitraturia. There are few data regarding the natural evolution of kidney stone events and chronic kidney disease in these patients, and there is a need for new treatments limiting kidney injury by calcium oxalate crystallization.