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Yang W, Zhao T, Chen X, Wang S, Wang Y, Su T. Determinants and impact of calcium oxalate crystal deposition on renal outcomes in acute kidney injury patients. Ren Fail 2024; 46:2334396. [PMID: 38570195 PMCID: PMC10993744 DOI: 10.1080/0886022x.2024.2334396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/19/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVES Calcium oxalate (CaOx) crystal deposition in acute kidney injury (AKI) patients is under recognized but impacts renal outcomes. This study investigates its determinants and effects. METHODS We studied 814 AKI patients with native kidney biopsies from 2011 to 2020, identifying CaOx crystal deposition severity (mild: <5, moderate: 5-10, severe: >10 crystals per section). We assessed factors like urinary oxalate, citrate, urate, electrolytes, pH, tubular calcification index, and SLC26A6 expression, comparing them with creatinine-matched AKI controls without oxalosis. We analyzed how these factors relate to CaOx severity and their impact on renal recovery (eGFR < 15 mL/min/1.73 m2 at 3-month follow-up). RESULTS CaOx crystal deposition was found in 3.9% of the AKI cohort (32 cases), with 72% due to nephrotoxic medication-induced tubulointerstitial nephritis. Diuretic use, higher urinary oxalate-to-citrate ratio induced by hypocitraturia, and tubular calcification index were significant contributors to moderate and/or severe CaOx deposition. Poor baseline renal function, low urinary chloride, high uric acid and urea nitrogen, tubular SLC26A6 overexpression, and glomerular sclerosis were also associated with moderate-to-severe CaOx deposition. Kidney recovery was delayed, with 43.8%, 31.2%, and 18.8% of patients having eGFR < 15 mL/min/1.73 m2 at 4, 12, and 24-week post-injury. Poor outcomes were linked to high urinary α1-microglobulin-to-creatinine (α1-MG/C) ratios and active tubular injury scores. Univariate analysis showed a strong link between this ratio and poor renal outcomes, independent of oxalosis severity. CONCLUSIONS In AKI, CaOx deposition is common despite declining GFR. Factors worsening tubular injury, not just oxalate-to-citrate ratios, are key to understanding impaired renal recovery.
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Affiliation(s)
- Weiwei Yang
- Department of medicine, Renal Division, Peking University First Hospital, Peking University, Institute of Nephrology, Renal Pathology Center, Institute of Nephrology, Peking University, Beijing, PR China
- Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing, PR China
| | - Tao Zhao
- Department of medicine, Renal Division, Peking University First Hospital, Peking University, Institute of Nephrology, Renal Pathology Center, Institute of Nephrology, Peking University, Beijing, PR China
- Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing, PR China
| | - Xuejing Chen
- Department of medicine, Renal Division, Peking University First Hospital, Peking University, Institute of Nephrology, Renal Pathology Center, Institute of Nephrology, Peking University, Beijing, PR China
- Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing, PR China
| | - Suxia Wang
- Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing, PR China
- Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Yu Wang
- Department of medicine, Renal Division, Peking University First Hospital, Peking University, Institute of Nephrology, Renal Pathology Center, Institute of Nephrology, Peking University, Beijing, PR China
- Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing, PR China
| | - Tao Su
- Department of medicine, Renal Division, Peking University First Hospital, Peking University, Institute of Nephrology, Renal Pathology Center, Institute of Nephrology, Peking University, Beijing, PR China
- Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing, PR China
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Christensen D, Tuluc M, Faro SH, Udare A, Gargano S. Sinonasal Oxalosis due to Fungal Rhinosinusitis: A Unique Case of a Destructive Pseudotumor. Int J Surg Pathol 2024; 32:601-606. [PMID: 37424352 DOI: 10.1177/10668969231185073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Oxalosis refers to the accumulation of calcium oxalate crystals in various organs and tissues, most commonly due to Aspergillus infection involving the lung or sinonasal tract. Both invasive and noninvasive forms of fungal rhinosinusitis can be associated with calcium oxalate crystal deposition. Here, we report a unique case of sinonasal oxalosis presenting as a destructive lesion in the absence of invasive fungal disease. Due to the clinical and pathologic significance of calcium oxalate crystals as seen in this patient, specimens from the sinonasal tract should be evaluated for the presence of these crystals, which may be a surrogate marker for fungal infection and may also independently cause tissue destruction.
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Affiliation(s)
- Daniel Christensen
- Department of Surgical Pathology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Madalina Tuluc
- Department of Surgical Pathology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Scott H Faro
- Department of Radiology and Neurology, Division of Neuroradiology and ENT, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ashlesha Udare
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Stacey Gargano
- Department of Surgical Pathology, Thomas Jefferson University, Philadelphia, PA, USA
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Nasr SH, Valeri AM, Said SM, Sethi S, Nath KA, Lieske JC, Bu L. Clinicopathologic Characteristics, Etiologies, and Outcome of Secondary Oxalate Nephropathy. Mayo Clin Proc 2024; 99:593-606. [PMID: 38310502 PMCID: PMC11017309 DOI: 10.1016/j.mayocp.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 02/05/2024]
Abstract
OBJECTIVE To report the clinicopathologic characteristics, prognostic indicators, prognosis, and transplant outcome of secondary oxalate nephropathy (ON). PATIENTS AND METHODS We performed a retrospective analysis of 113 consecutive patients with secondary ON diagnosed at Mayo Clinic in Rochester, Minnesota, between January 1, 2001, and March 1, 2023. RESULTS The incidence of secondary ON among all native biopsies from Mayo Clinic patients over the study period (n=11,617) was 0.97%. ON was attributed to enteric hyperoxaluria in 60% of the 113 patients (68; most commonly Roux-en-Y gastric bypass), excessive ingestion of foods high in oxalate or oxalate precursors in 23% (26) (most commonly vitamin C), and idiopathic in 17% (19). Most patients presented with acute kidney injury (AKI) (particularly in the ingestion group) or AKI on chronic kidney disease, and 53% (60 of 113) were diabetic. Calcium oxalate crystals were accompanied by acute tubular injury, inflammation, and interstitial fibrosis and tubular atrophy. Concurrent pathologic conditions were present in 53% of the patients (60 of 113), most commonly diabetic nephropathy. After a median follow-up of 36 months, 27% of the patients (30 of 112) had kidney recovery, 19% (21 of 112) had persistent kidney dysfunction, 54% (61 of 112) had development of kidney failure, and 29% (32 of 112) died. The mean kidney survival was worse for patients with a concurrent pathologic lesion (30 months vs 96 months for those without a concurrent pathologic lesion; P<.001). Independent predictors of kidney failure were the degree of interstitial fibrosis and tubular atrophy and nadir estimated glomerular filtration rate but not the degree of crystal deposition. After a median follow-up of 58 months in 23 patients who received kidney transplant, 4 had graft loss (due to ON in 3). The 2-, 5-, and 10-year graft survivals were 90% (18 of 20), 79% (11 of 14), and 50% (6 of 12). CONCLUSION ON is a rare cause of AKI or AKI on chronic kidney disease. Most patients have comorbid pathologic conditions, particularly diabetic nephropathy, which worsen the prognosis. Recurrence in the renal allograft and graft loss may occur if hyperoxaluria is not controlled.
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Affiliation(s)
- Samih H Nasr
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
| | - Anthony M Valeri
- Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Samar M Said
- Department of Pathology, Olmsted Medical Center, Rochester, MN
| | - Sanjeev Sethi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Karl A Nath
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - John C Lieske
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Lihong Bu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Bakkaloğlu SA, Büyükkaragöz B, Pınarbaşı AS, Leventoğlu E, Saygılı S, Çomak E, Yıldırım ZY, Akıncı N, Dursun İ, Karabay Bayazıt A, Kavaz Tufan A, Akman S, Yılmaz A, Noyan A, Ağbaş A, Serdaroğlu E, Delibaş A, Elmacı AM, Taşdemir M, Ezgü FS, Sever L. Comprehensive evaluation of patients with primary hyperoxaluria type 1: A nationwide study. Nephrology (Carlton) 2024; 29:201-213. [PMID: 38290500 DOI: 10.1111/nep.14273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/10/2024] [Accepted: 01/14/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Primary hyperoxaluria type 1 (PH1) is characterized by increased endogenous oxalate production and deposition as calcium oxalate crystals. The main manifestations are nephrocalcinosis/nephrolithiasis, causing impaired kidney function. We aimed to evaluate the clinical characteristics and overall outcomes of paediatric PH1 patients in Turkey. METHODS This is a nationwide, multicentre, retrospective study evaluating all available paediatric PH1 patients from 15 different paediatric nephrology centres in Turkey. Detailed patient data was collected which included demographic, clinical and laboratory features. Patients were classified according to their age and characteristics at presentation: patients presenting in the first year of life with nephrocalcinosis/nephrolithiasis (infantile oxalosis, Group 1), cases with recurrent nephrolithiasis diagnosed during childhood (childhood-onset PH1, Group 2), and asymptomatic children diagnosed with family screening (Group 3). RESULTS Forty-eight patients had a mutation consistent with PH1. The most common mutation was c.971_972delTG (25%). Infantile oxalosis patients had more advanced chronic kidney disease (CKD) or kidney failure necessitating dialysis (76.9% vs. 45.5%). These patients had much worse clinical course and mortality rates seemed to be higher (23.1% vs. 13.6%). Patients with fatal outcomes were the ones with significant comorbidities, especially with cardiovascular involvement. Patients in Group 3 were followed with better outcomes, with no kidney failure or mortality. CONCLUSION PH1 is not an isolated kidney disease but a systemic disease. Family screening helps to preserve kidney function and prevent systemic complications. Despite all efforts made with traditional treatment methods including transplantation, our results show devastating outcomes or mortality.
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Affiliation(s)
| | | | - Ayşe Seda Pınarbaşı
- Diyarbakır Children's Hospital, Pediatric Nephrology Unit, Diyarbakır, Turkey
| | - Emre Leventoğlu
- Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
| | - Seha Saygılı
- Cerrahpaşa Faculty of Medicine, Department of Pediatric Nephrology, İstanbul University, İstanbul, Turkey
| | - Elif Çomak
- Department of Pediatric Nephrology, Akdeniz University, Antalya, Turkey
| | - Zeynep Y Yıldırım
- İstanbul Faculty of Medicine, Department of Pediatric Nephrology, Istanbul University, İstanbul, Turkey
| | - Nurver Akıncı
- Department of Pediatric Nephrology, Şişli Etfal Research and Training Hospital, İstanbul, Turkey
| | - İsmail Dursun
- Department of Pediatric Nephrology, Erciyes University, Kayseri, Turkey
| | | | - Aslı Kavaz Tufan
- Department of Pediatric Nephrology, Osmangazi University, Eskişehir, Turkey
| | - Sema Akman
- Department of Pediatric Nephrology, Akdeniz University, Antalya, Turkey
| | - Alev Yılmaz
- İstanbul Faculty of Medicine, Department of Pediatric Nephrology, Istanbul University, İstanbul, Turkey
| | - Aytül Noyan
- Adana Hospital, Department of Pediatric Nephrology, Başkent University, Adana, Turkey
| | - Ayşe Ağbaş
- Department of Pediatric Nephrology, Haseki Research and Training Hospital, İstanbul, Turkey
| | - Erkin Serdaroğlu
- Department of Pediatric Nephrology, Dr. Behçet Uz Children Hospital, İzmir, Turkey
| | - Ali Delibaş
- Department of Pediatric Nephrology, Mersin University, Mersin, Turkey
| | - Ahmet Midhat Elmacı
- Pediatric Nephrology Unit, Konya Maternal and Children Hospital, Konya, Turkey
| | - Mehmet Taşdemir
- Department of Pediatric Nephrology, İstinye University, İstanbul, Turkey
| | - Fatih S Ezgü
- Department of Pediatric Inborn Metabolic Disorders, Gazi University, Ankara, Turkey
- Department of Pediatric Genetic Disorders, Gazi University, Ankara, Turkey
| | - Lale Sever
- Cerrahpaşa Faculty of Medicine, Department of Pediatric Nephrology, İstanbul University, İstanbul, Turkey
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Barani C, Aydin S, Demoulin N, Jadoul M. Oxalate nephropathy after pancreaticoduodenectomy: a case report. BMC Nephrol 2024; 25:106. [PMID: 38500054 PMCID: PMC10949820 DOI: 10.1186/s12882-024-03543-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 03/12/2024] [Indexed: 03/20/2024] Open
Abstract
A 75-year-old male developed acute kidney injury KDIGO stage 3 a few weeks after Whipple surgery was performed for a distal cholangiocarcinoma. Kidney biopsy revealed oxalate nephropathy. This was attributed to post-Whipple malabsorption, poor compliance with pancreatic enzyme replacement therapy, and daily intake of vitamin C supplements. Pancreatic enzyme replacement therapy was resumed and calcium carbonate initiated, with an improvement in glomerular filtration rate. Unfortunately, due to oncological progression, best supportive care was initiated.We review the pathophysiology and conditions predisposing to secondary hyperoxaluria and oxalate nephropathy. This diagnosis should be considered among the main causes of acute kidney injury following pancreatectomy, with important therapeutic implications.
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Affiliation(s)
- Claire Barani
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, B-1200, Brussels, Belgium
| | - Selda Aydin
- Division of Pathology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, B-1200, Brussels, Belgium
| | - Nathalie Demoulin
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, B-1200, Brussels, Belgium
| | - Michel Jadoul
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, B-1200, Brussels, Belgium.
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Siener R, Ernsten C, Speller J, Scheurlen C, Sauerbruch T, Hesse A. Intestinal Oxalate Absorption, Enteric Hyperoxaluria, and Risk of Urinary Stone Formation in Patients with Crohn's Disease. Nutrients 2024; 16:264. [PMID: 38257157 PMCID: PMC10821467 DOI: 10.3390/nu16020264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/13/2024] [Accepted: 01/14/2024] [Indexed: 01/24/2024] Open
Abstract
Nephrolithiasis is a common urologic manifestation of Crohn's disease. The purpose of this study was to investigate the clinical characteristics, intestinal oxalate absorption, and risk factors for urinary stone formation in these patients. In total, 27 patients with Crohn's disease and 27 healthy subjects were included in the present study. Anthropometric, clinical, and 24 h urinary parameters were determined, and the [13C2]oxalate absorption test was performed. Among all patients, 18 had undergone ileal resection, 9 of whom had a history of urinary stones. Compared to healthy controls, the urinary excretion values of calcium, magnesium, potassium, sulfate, creatinine, and citrate were significantly lower in patients with Crohn's disease. Intestinal oxalate absorption, the fractional and 24 h urinary oxalate excretion, and the risk of calcium oxalate stone formation were significantly higher in patients with urolithiasis than in patients without urolithiasis or in healthy controls. Regardless of the group, between 83% and 96% of the [13C2]oxalate was detected in the urine within the first 12 h after ingestion. The length of ileum resection correlated significantly with the intestinal absorption and urinary excretion of oxalate. These findings suggest that enteric hyperoxaluria can be attributed to the hyperabsorption of oxalate following extensive ileal resection. Oral supplementation of calcium and magnesium, as well as alkali citrate therapy, should be considered as treatment options for urolithiasis.
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Affiliation(s)
- Roswitha Siener
- University Stone Center, Department of Urology, University Hospital Bonn, 53127 Bonn, Germany; (C.E.); (A.H.)
| | - Charlotte Ernsten
- University Stone Center, Department of Urology, University Hospital Bonn, 53127 Bonn, Germany; (C.E.); (A.H.)
| | - Jan Speller
- Department of Medical Biometry, Informatics and Epidemiology, Medical Faculty, University of Bonn, 53127 Bonn, Germany;
| | - Christian Scheurlen
- Department of Internal Medicine I, University Hospital Bonn, 53127 Bonn, Germany; (C.S.); (T.S.)
| | - Tilman Sauerbruch
- Department of Internal Medicine I, University Hospital Bonn, 53127 Bonn, Germany; (C.S.); (T.S.)
| | - Albrecht Hesse
- University Stone Center, Department of Urology, University Hospital Bonn, 53127 Bonn, Germany; (C.E.); (A.H.)
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Washington O, Robinson E, Simh D, Magoo H, Verma A, Rennke H, Zonozi R. Oxalate nephropathy and chronic turmeric supplementation: a case report. J Bras Nefrol 2024; 46:99-106. [PMID: 38427579 PMCID: PMC10962410 DOI: 10.1590/2175-8239-jbn-2023-0079en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 11/03/2023] [Indexed: 01/18/2024] Open
Abstract
We present a case of a 69-year-old man who presented for routine check-up and was incidentally found to have kidney failure with an initially unrevealing history and bland urinary sediment. He was diagnosed with oxalate nephropathy in the setting of chronic turmeric supplementation and chronic antibiotic therapy with associated diarrhea. Our case provides several key insights into oxalate nephropathy. First, the diagnosis requires a high index of clinical suspicion. It is uncommonly suspected clinically unless there is an obvious clue in the history such as Roux-en-Y gastric bypass or ethylene glycol poisoning. Diagnosis can be confirmed by histopathologic findings and corroborated by serum levels of oxalate and 24-hour urinary excretion. Second, the diagnosis can often be missed by the pathologist because of the characteristics of the crystals unless the renal pathologist has made it a rule to examine routinely all H&E sections under polarized light. This must be done on H&E, as the other stains dissolve the crystals. Third, one oxalate crystal in a routine needle biopsy is considered pathologic and potentially contributing to the AKI or to the CKD in an important way. Fourth, secondary oxalosis can be largely mitigated or prevented in many cases, especially iatrogenic cases. This can come through the surgeon or the gastroenterologist providing proper instructions to patients on an oxalate-restricted diet or other specific dietary measures. Lastly, this case highlights the success that results from cooperation and communication between the pathologist and the treating physician.
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Affiliation(s)
- Onica Washington
- Brigham and Women's Hospital, Division of Nephrology, Boston, Massachusetts, USA
| | - Emily Robinson
- Brigham and Women's Hospital, Division of Nephrology, Boston, Massachusetts, USA
| | - Deetu Simh
- Saint Vincent Hospital, Division of Nephrology, Worcester, Massachusetts, USA
| | - Hemant Magoo
- Saint Vincent Hospital, Division of Nephrology, Worcester, Massachusetts, USA
| | - Ashish Verma
- Saint Vincent Hospital, Division of Nephrology, Worcester, Massachusetts, USA
| | - Helmut Rennke
- Brigham and Women's Hospital, Department of Pathology, Boston, Massachusetts, USA
| | - Reza Zonozi
- Massachusetts General Hospital, Division of Nephrology, Boston, Massachusetts, USA
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Llanos M, Kwon A, Herlitz L, Shafi T, Cohen S, Gebreselassie SK, Sawaf H, Bobart SA. The Clinical and Pathological Characteristics of Patients with Oxalate Nephropathy. Kidney360 2024; 5:65-72. [PMID: 38095544 PMCID: PMC10833593 DOI: 10.34067/kid.0000000000000340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/01/2023] [Indexed: 01/26/2024]
Abstract
Key Points Oxalate nephropathy is an underrecognized cause of CKD and ESKD We present one of the largest native oxalate nephropathy cohorts to date from a tertiary care institution in the United States Oxalate nephropathy has multiple etiologies and given its clinical course and poor prognosis, attention must be paid to screening for risk factors to guide prompt diagnosis and management Background Oxalate nephropathy (ON) is characterized by deposition of calcium oxalate crystals in the kidney and is commonly under-recognized. Causes of ON include primary hyperoxaluria, enteric hyperoxaluria, and ingestion of excess oxalate or its precursors. Methods We report the clinical and pathological characteristics of one of the largest series of native kidney ON to date, from January 2015 to March 2023 at the Cleveland Clinic. Results We identified 60 native biopsies with oxalate deposits and excluded patients with clinically insignificant biopsies (n =12) or lack of data (n =17). Thirty-one patients with native ON were described. The mean age at diagnosis was 66.2 years (±12.1), and 58.1% were female. 87.1% had hypertension, 58.1% had diabetes, 42% had nephrolithiasis, and 77.4% had underlying CKD, with a mean baseline creatinine of 1.8 mg/dl ±1.3. The mean creatinine at biopsy was 5.2 mg/dl ±1.7. Kidney biopsies showed abundant calcium oxalate crystal deposits, and 27 of 31 biopsies had additional diagnoses, the most common of which were acute tubular injury n =17 (54.8%) and diabetic glomerulosclerosis n =7 (22.6%). Severe and moderate interstitial fibrosis was present in 38.7% (n =12) and 51.6% (n =16) of biopsies, respectively. Ten had a single etiology of ON, ten had a multifactorial etiology (both enteric hyperoxaluria and high precursor intake), and 11 had an unclear etiology. Notably, only seven patients had a history of gastric bypass. The mean duration of follow-up was 26.8 months, and 26 patients had follow-up data >1 year. Of these, 21 required dialysis, and five were dialysis-free at presentation. Five of the 26 were deceased at 1 year, with 12 patients (38.7%) deceased at last follow-up. Seventeen patients received targeted management, while nine patients did not receive targeted treatment, and all nine required hemodialysis. More patients (31.6%) had vitamin C intake after the coronavirus disease 2019 pandemic (2020–2023) versus 16.7% before 2020. Conclusions ON presents as AKI or acute on CKD. The prognosis is poor with most patients requiring dialysis at presentation with high morbidity and mortality. Clinicians need to be aware of the risk factors associated with ON to aid prompt diagnosis and management. Podcast This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/K360/2024_01_26_KID0000000000000340.mp3
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Affiliation(s)
- Maria Llanos
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Alvin Kwon
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Leal Herlitz
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Tariq Shafi
- Division of Kidney Diseases, Hypertension, & Transplantation, Houston Methodist Hospital, Houston, Texas
| | - Scott Cohen
- Department of Kidney Medicine, Cleveland Clinic Florida, Weston, Florida
| | | | - Hanny Sawaf
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Shane A. Bobart
- Division of Kidney Diseases, Hypertension, & Transplantation, Houston Methodist Hospital, Houston, Texas
- Department of Kidney Medicine, Cleveland Clinic Florida, Weston, Florida
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Owino C, Mutugi A, Tang J. Hyperoxaluria - A Major Metabolic Risk for Kidney Stone Disease. R I Med J (2013) 2023; 106:14-19. [PMID: 38015779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Hyperoxaluria is a clinically relevant metabolic entity that portends a high morbidity burden. Primarily manifesting as kidney stone disease and chronic kidney disease, advanced hyperoxaluria can also affect major organs, including the brain, heart, liver, bone, and the skin. It is categorized based on etiology into primary and secondary hyperoxaluria. Pathology is attributed to excess de novo oxalate production in the former and multifactorial exogenous oxalate absorption or excess intake of its precursors in the latter. Diagnosis often involves demonstrating elevated urinary oxalate levels, especially in patients with normal kidney function. Here in this review, we will perform an in-depth discussion of various causes of hyperoxaluria and describe treatment options. In view of the significant morbidity burden associated with hyperoxaluria, patients could benefit from heightened clinician awareness to aid in the timely diagnosis and management of this condition.
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Affiliation(s)
- Christopher Owino
- Visiting scholar, Division of Kidney Diseases and Hypertension, Alpert Medical School of Brown University, Providence, RI. Medical resident, Department of Medicine, Moi University Teaching and Referral Hospital, Eldoret, Kenya
| | - Ann Mutugi
- Visiting scholar, Division of Kidney Diseases and Hypertension, Alpert Medical School of Brown University, Providence, RI. Medical resident, Department of Medicine, Moi University Teaching and Referral Hospital, Eldoret, Kenya
| | - Jie Tang
- Associate Professor of Medicine, Division of Kidney Diseases and Hypertension, Alpert Medical School of Brown University, Providence, RI
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10
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Langman CB, Assimos D, Blank M, Calle J, Grauer A, Kausz A, Milliner D, Nazzal L, Smith K, Tasian G, Thompson A, Wood KD, Worcester E, Yang S, Malley MA, Knauf F, Lieske JC. End Point Considerations for Clinical Trials in Enteric Hyperoxaluria. Clin J Am Soc Nephrol 2023; 18:1637-1644. [PMID: 37342976 PMCID: PMC10723917 DOI: 10.2215/cjn.0000000000000234] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/14/2023] [Indexed: 06/23/2023]
Abstract
Enteric hyperoxaluria is a medical condition characterized by elevated urinary oxalate excretion due to increased gastrointestinal oxalate absorption. Causative features include fat malabsorption and/or increased intestinal permeability to oxalate. Enteric hyperoxaluria has long been known to cause nephrolithiasis and nephrocalcinosis, and, more recently, an association with CKD and kidney failure has been shown. Currently, there are no US Food and Drug Administration-approved therapies for enteric hyperoxaluria, and it is unclear what end points should be used to evaluate the efficacy of new drugs and biologics for this condition. This study represents work of a multidisciplinary group convened by the Kidney Health Initiative to review the evidence supporting potential end points for clinical trials in enteric hyperoxaluria. A potential clinical outcome is symptomatic kidney stone events. Potential surrogate end points include ( 1 ) an irreversible loss of kidney function as a surrogate for progression to kidney failure, ( 2 ) asymptomatic kidney stone growth/new stone formation observed on imaging as a surrogate for symptomatic kidney stone events, ( 3 ) urinary oxalate and urinary calcium oxalate supersaturation as surrogates for the development of symptomatic kidney stone events, and ( 4) plasma oxalate as a surrogate for the development of the clinical manifestations of systemic oxalosis. Unfortunately, because of gaps in the data, this Kidney Health Initiative workgroup was unable to provide definitive recommendations. Work is underway to obtain robust information that can be used to inform trial design and medical product development in this space.
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Affiliation(s)
- Craig B. Langman
- Feinberg School of Medicine, Department of Pediatrics, Northwestern University, Chicago, Illinois
| | - Dean Assimos
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Melanie Blank
- Office of Therapeutic Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Juan Calle
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Dawn Milliner
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Lama Nazzal
- Department of Medicine, Division of Nephrology, New York University School of Medicine, NYU Langone Health, New York, New York
| | - Kimberly Smith
- Office of Medical Policy, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Greg Tasian
- University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Aliza Thompson
- Division of Cardiology and Nephrology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Kyle D. Wood
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elaine Worcester
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Sixun Yang
- Division of Vaccines and Related Products Applications, Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | | | - Felix Knauf
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - John C. Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
- Department of Laboratory Medicine and Nephrology, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
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11
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Yang B, Wang G, Li Y, Yang T, Guo H, Li P, Li J. Hydroxycitric acid prevents hyperoxaluric-induced nephrolithiasis and oxidative stress via activation of the Nrf2/Keap1 signaling pathway. Cell Cycle 2023; 22:1884-1899. [PMID: 37592762 PMCID: PMC10599177 DOI: 10.1080/15384101.2023.2247251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 07/11/2023] [Accepted: 07/21/2023] [Indexed: 08/19/2023] Open
Abstract
Nephrolithiasis is a common and frequently-occurring disease in the urinary system with high recurrence. The present study aimed to explore the protective effect and underlying mechanism of hydroxycitric acid (HCA) in hyperoxaluria-induced nephrolithiasis in vitro and in vivo. Crystal deposition and pathophysiological injury in rat models of glyoxylate-induced nephrolithiasis were examined using H&E staining. Cell models of nephrolithiasis were established by oxalate-treated renal tubular epithelial cells. The levels of oxidative stress indexes were determined by ELISA kits. Cell proliferation in vivo and in vitro was evaluated using a cell counting kit-8 (CCK-8) assay and Ki-67 cell proliferation detection kit. Cell apoptosis was measured by flow cytometry and TUNEL staining. The protein levels were examined by western blotting. Our results showed that HCA administration significantly reduced crystal deposition and kidney injury induced by glyoxylate. HCA also alleviated oxidative stress via upregulating the antioxidant enzyme activities of superoxide dismutase (SOD) and catalase (CAT) and reducing the malondialdehyde (MDA) content. Moreover, HCA treatment promoted cell proliferation and inhibited apoptosis of renal tubular epithelial cells exposed to hyperoxaluria. Of note, Nrf2 activator dimethyl fumarate (DMF) exerted the same beneficial effects as HCA in nephrolithiasis. Mechanistically, HCA prevented crystal deposition and oxidative stress induced by hyperoxaluria through targeting the Nrf2/Keap1 antioxidant defense pathway, while knockdown of Nrf2 significantly abrogated these effects. Taken together, HCA exhibited antioxidation and anti-apoptosis activities in nephrolithiasis induced by hyperoxaluria via activating Nrf2/Keap1 pathway, suggesting that it may be an effective therapeutic agent for the prevention and treatment of nephrolithiasis.
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Affiliation(s)
- Bowei Yang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Guang Wang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Yuhang Li
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Tongxin Yang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Haixiang Guo
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Pei Li
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Jiongming Li
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
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12
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Wang X, Zhang X, Wang L, Zhang R, Zhang Y, Cao L. Purslane-induced oxalate nephropathy: case report and literature review. BMC Nephrol 2023; 24:207. [PMID: 37443012 PMCID: PMC10347717 DOI: 10.1186/s12882-023-03236-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 06/08/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The kidney is particularly vulnerable to toxins due to its abundant blood supply, active tubular reabsorption, and medullary interstitial concentration. Currently, calcium phosphate-induced and calcium oxalate-induced nephropathies are the most common crystalline nephropathies. Hyperoxaluria may lead to kidney stones and progressive kidney disease due to calcium oxalate deposition leading to oxalate nephropathy. Hyperoxaluria can be primary or secondary. Primary hyperoxaluria is an autosomal recessive disease that usually develops in childhood, whereas secondary hyperoxaluria is observed following excessive oxalate intake or reduced excretion, with no difference in age of onset. Oxalate nephropathy may be overlooked, and the diagnosis is often delayed or missed owning to the physician's inadequate awareness of its etiology and pathogenesis. Herein, we discuss the pathogenesis of hyperoxaluria with two case reports, and our report may be helpful to make appropriate treatment plans in clinical settings in the future. CASE PRESENTATION We report two cases of acute kidney injury, which were considered to be due to oxalate nephropathy in the setting of purslane (portulaca oleracea) ingestion. The two patients were elderly and presented with oliguria, nausea, vomiting, and clinical manifestations of acute kidney injury requiring renal replacement therapy. One patient underwent an ultrasound-guided renal biopsy, which showed acute tubulointerstitial injury and partial tubular oxalate deposition. Both patients underwent hemodialysis and were discharged following improvement in creatinine levels. CONCLUSIONS Our report illustrates two cases of acute oxalate nephropathy in the setting of high dietary consumption of purslane. If a renal biopsy shows calcium oxalate crystals and acute tubular injury, oxalate nephropathy should be considered and the secondary causes of hyperoxaluria should be eliminated.
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Affiliation(s)
- Xiangtuo Wang
- Department of Nephrology, Harrison International Peace Hospital, Renmin Road, Hengshui, 053000, Hebei Province, People's Republic of China.
| | - Xiaoyan Zhang
- Department of Nephrology, Harrison International Peace Hospital, Renmin Road, Hengshui, 053000, Hebei Province, People's Republic of China
| | - Liyuan Wang
- Department of Nephrology, Harrison International Peace Hospital, Renmin Road, Hengshui, 053000, Hebei Province, People's Republic of China
| | - Ruiying Zhang
- Department of Nephrology, Harrison International Peace Hospital, Renmin Road, Hengshui, 053000, Hebei Province, People's Republic of China
| | - Yingxuan Zhang
- Department of Nephrology, Harrison International Peace Hospital, Renmin Road, Hengshui, 053000, Hebei Province, People's Republic of China
| | - Lei Cao
- Department of Nephrology, Harrison International Peace Hospital, Renmin Road, Hengshui, 053000, Hebei Province, People's Republic of China.
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13
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Arnous MG, Vaughan L, Mehta RA, Schulte PJ, Lieske JC, Milliner DS. Characterization of Stone Events in Patients With Type 3 Primary Hyperoxaluria. J Urol 2023; 209:1141-1150. [PMID: 36888927 PMCID: PMC11034812 DOI: 10.1097/ju.0000000000003400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/28/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE Hallmarks of primary hyperoxaluria type 3 are nephrolithiasis and hyperoxaluria. However, little is known about factors influencing stone formation in this disease. We characterized stone events and examined associations with urine parameters and kidney function in a primary hyperoxaluria type 3 population. MATERIALS AND METHODS We retrospectively analyzed clinical, and laboratory data of 70 primary hyperoxaluria type 3 patients enrolled in the Rare Kidney Stone Consortium Primary Hyperoxaluria Registry. RESULTS Kidney stones occurred in 65/70 primary hyperoxaluria type 3 patients (93%). Among the 49 patients with imaging available, the median (IQR) number of stones was 4 (2, 5), with largest stone 7 mm (4, 10) at first imaging. Clinical stone events occurred in 62/70 (89%) with median number of events per patient 3 (2, 6; range 1-49). Age at first stone event was 3 years (0.99, 8.7). Lifetime stone event rate was 0.19 events/year (0.12, 0.38) during follow-up of 10.7 (4.2, 26.3) years. Among 326 total clinical stone events, 139 (42.6%) required surgical intervention. High stone event rates persisted for most patients through the sixth decade of life. Analysis was available for 55 stones: pure calcium oxalate accounted for 69%, with mixed calcium oxalate and phosphate in 22%. Higher calcium oxalate supersaturation was associated with increased lifetime stone event rate after adjusting for age at first event (IRR [95%CI] 1.23 [1.16, 1.32]; P < .001). By the fourth decade, estimated glomerular filtration rate was lower in primary hyperoxaluria type 3 patients than the general population. CONCLUSIONS Stones impose a lifelong burden on primary hyperoxaluria type 3 patients. Reducing urinary calcium oxalate supersaturation may reduce event frequency and surgical intervention.
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Affiliation(s)
- Muhammad G. Arnous
- Divison of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Lisa Vaughan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Ramila A. Mehta
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Phillip J. Schulte
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - John C. Lieske
- Divison of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dawn S. Milliner
- Divison of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
- Division of Pediatric Nephrology, Mayo Clinic, Rochester, MN USA
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14
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Xiao J, Li D, Liu G, Wang D. A case of acute oxalate nephropathy after colonoscopy. Clin Nephrol 2023; 99:206-208. [PMID: 36871225 DOI: 10.5414/cn110978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 03/06/2023] Open
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15
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Zhu W, Wu C, Zhou Z, Zhang G, Luo L, Liu Y, Huang Z, Ai G, Zhao Z, Zhong W, Liu Y, Zeng G. Acetate attenuates hyperoxaluria-induced kidney injury by inhibiting macrophage infiltration via the miR-493-3p/MIF axis. Commun Biol 2023; 6:270. [PMID: 36922584 PMCID: PMC10017675 DOI: 10.1038/s42003-023-04649-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 03/02/2023] [Indexed: 03/18/2023] Open
Abstract
Hyperoxaluria is well known to cause renal injury and end-stage kidney disease. Previous studies suggested that acetate treatment may improve the renal function in hyperoxaluria rat model. However, its underlying mechanisms remain largely unknown. Using an ethylene glycol (EG)-induced hyperoxaluria rat model, we find the oral administration of 5% acetate reduced the elevated serum creatinine, urea, and protected against hyperoxaluria-induced renal injury and fibrosis with less infiltrated macrophages in the kidney. Treatment of acetate in renal tubular epithelial cells in vitro decrease the macrophages recruitment which might have reduced the oxalate-induced renal tubular cells injury. Mechanism dissection suggests that acetate enhanced acetylation of Histone H3 in renal tubular cells and promoted expression of miR-493-3p by increasing H3K9 and H3K27 acetylation at its promoter region. The miR-493-3p can suppress the expression of macrophage migration inhibitory factor (MIF), thus inhibiting the macrophages recruitment and reduced oxalate-induced renal tubular cells injury. Importantly, results from the in vivo rat model also demonstrate that the effects of acetate against renal injury were weakened after blocking the miR-493-3p by antagomir treatment. Together, these results suggest that acetate treatment ameliorates the hyperoxaluria-induced renal injury via inhibiting macrophages infiltration with change of the miR-493-3p/MIF signals. Acetate could be a new therapeutic approach for the treatment of oxalate nephropathy.
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Affiliation(s)
- Wei Zhu
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, 510230, Guangzhou, Guangdong, China
| | - Chengjie Wu
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, 510230, Guangzhou, Guangdong, China
- Breast Center, Department of General Surgery, Southern Medical University Nanfang Hospital, 510230, Guangzhou, Guangdong, China
| | - Zhen Zhou
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, 510230, Guangzhou, Guangdong, China
| | - Guangyuan Zhang
- Department of Urology, Zhongda Hospital Southeast University, 210009, Nanjing, Jiangsu, China
| | - Lianmin Luo
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, 510230, Guangzhou, Guangdong, China
| | - Yang Liu
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, 510230, Guangzhou, Guangdong, China
| | - Zhicong Huang
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, 510230, Guangzhou, Guangdong, China
| | - Guoyao Ai
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, 510230, Guangzhou, Guangdong, China
| | - Zhijian Zhao
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, 510230, Guangzhou, Guangdong, China
| | - Wen Zhong
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, 510230, Guangzhou, Guangdong, China
| | - Yongda Liu
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, 510230, Guangzhou, Guangdong, China
| | - Guohua Zeng
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, 510230, Guangzhou, Guangdong, China.
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16
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Aziz F, Jorgenson M, Garg N. Secondary oxalate nephropathy and kidney transplantation. Curr Opin Organ Transplant 2023; 28:15-21. [PMID: 36342385 DOI: 10.1097/mot.0000000000001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE OF REVIEW Secondary hyperoxaluria is associated with poor kidney allograft outcomes after the kidney transplant. Calcium oxalate (CaOx) deposition is common in early allograft biopsies leading to acute tubular necrosis and poor kidney allograft function. Though treatment options for secondary hyperoxaluria are limited, it is crucial to identify patients at increased risk of oxalate nephropathy after the transplant. RECENT FINDINGS Recent data suggest that significant changes in renal replacement therapies and dietary modifications in high-risk patients can prevent kidney allograft damage from the calcium oxalate deposition leading to improve allograft outcomes. SUMMARY The accurate and timely diagnosis of secondary oxalate nephropathy in kidney transplant recipients is paramount to preserving graft function in the long-term. This review will discuss the incidence, risk factors, prevention, and management of oxalate nephropathy in the kidney allograft.
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Affiliation(s)
- Fahad Aziz
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health
| | - Margaret Jorgenson
- Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA
| | - Neetika Garg
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health
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17
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Mandal A, Khandelwal P, Geetha TS, Murugan S, Meena J, Jana M, Sinha A, Kumar R, Seth A, Hari P, Bagga A. Metabolic and Genetic Evaluation in Children with Nephrolithiasis. Indian J Pediatr 2022; 89:1243-1250. [PMID: 35819704 DOI: 10.1007/s12098-022-04234-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/07/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate metabolic and genetic abnormalities in children with nephrolithiasis attending a referral center in North India. METHODS The patients aged 1-18 y old with nephrolithiasis underwent biochemical evaluation and whole-exome sequencing. The authors evaluated for monogenic variants in 56 genes and compared allele frequency of 39 reported polymorphisms between patients and 1739 controls from the GenomeAsia 100 K database. RESULTS Fifty-four patients, aged 9.1 ± 3.7 y were included. Stones were bilateral in 42.6%, familial in 33.3%, and recurrent in 25.9%. The most common metabolic abnormalities were hypercalciuria (35.2%), hyperoxaluria (24.1%), or both (11.1%), while xanthinuria (n = 3), cystinuria (n = 1), and hyperuricosuria (n = 1) were rare. Exome sequencing identified an etiology in 6 (11.1%) patients with pathogenic/likely pathogenic causative variants. Three variants in MOCOS and one in ATP7B were pathogenic; likely pathogenic variants included MOCOS (n = 2), AGXT, and SLC7A9 (n = 1, each). Causality was not attributed to two SLC34A1 likely pathogenic variants, due to lack of matching phenotype and dominant family history. Compared to controls, allele frequency of the polymorphism TRPV5 rs4252402 was significantly higher in familial stone disease (allele frequency 0.47 versus 0.53; OR 3.2, p = 0.0001). CONCLUSION The chief metabolic abnormalities were hypercalciuria and hyperoxaluria. A monogenic etiology was identified in 11% with pathogenic or likely pathogenic variants using a gene panel for nephrolithiasis. Heterozygous missense variants in the sodium-phosphate cotransporter SLC34A1 were common and required evaluation for attributing pathogenicity. Rare polymorphisms in TRPV5 might increase the risk of familial stones. These findings suggest that a combination of metabolic and genetic evaluation is useful for determining the etiology of nephrolithiasis.
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Affiliation(s)
- Anita Mandal
- Division of Nephrology, Department of Pediatrics, ICMR Center for Advanced Research in Kidney Diseases, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Priyanka Khandelwal
- Division of Nephrology, Department of Pediatrics, ICMR Center for Advanced Research in Kidney Diseases, All India Institute of Medical Sciences, New Delhi, 110029, India
| | | | | | - Jitendra Meena
- Division of Nephrology, Department of Pediatrics, ICMR Center for Advanced Research in Kidney Diseases, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Manisha Jana
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Aditi Sinha
- Division of Nephrology, Department of Pediatrics, ICMR Center for Advanced Research in Kidney Diseases, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Amlesh Seth
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Hari
- Division of Nephrology, Department of Pediatrics, ICMR Center for Advanced Research in Kidney Diseases, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Arvind Bagga
- Division of Nephrology, Department of Pediatrics, ICMR Center for Advanced Research in Kidney Diseases, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Bianco J, Chu F, Bergsland K, Coe F, Worcester E, Prochaska M. What treatments reduce kidney stone risk in patients with bowel disease? Urolithiasis 2022; 50:557-565. [PMID: 35976425 PMCID: PMC9972896 DOI: 10.1007/s00240-022-01352-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 08/05/2022] [Indexed: 12/30/2022]
Abstract
We examined how physicians made therapeutic choices to decrease stone risk in patients with bowel disease without colon resection, many of whom have enteric hyperoxaluria (EH), at a single clinic. We analyzed clinic records and 24-h urine collections before and after the first clinic visit, among 100 stone formers with bowel disease. We used multivariate linear regression and t tests to compare effects of fluid intake, alkali supplementation, and oxalate-focused interventions on urine characteristics. Patients advised to increase fluid intake had lower initial urine volumes (L/day; 1.3 ± 0.5 vs. 1.7 ± 0.7) and increased volume more than those not so advised (0.7 ± 0.6 vs. 0.3 ± 0.6 p = 0.03; intervention vs. non-intervention). Calcium oxalate supersaturation (CaOx SS) fell (95% CI -4.3 to -0.8). Alkali supplementation increased urine pH (0.34 ± 0.53 vs. 0.22 ± 0.55, p = 0.26) and urine citrate (mg/d; 83 ± 256 vs. 98 ± 166, p = 0.74). Patients advised to reduce oxalate (mg/day) absorption had higher urine oxalate at baseline (88 ± 44 vs. 50 ± 26) which was unchanged on follow-up (88 (baseline) vs. 91 (follow-up), p = 0.90). Neither alkali (95% CI -1.4 to 2.1) nor oxalate-focused advice (95% CI -1.2 to 2.3) lowered CaOx SS. Physicians chose treatments based on baseline urine characteristics. Advice to increase fluid intake increased urine volume and decreased CaOx SS. Alkali and oxalate interventions were ineffective.
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Affiliation(s)
- Julianna Bianco
- Department of Medicine, Nephrology Section/MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Francesca Chu
- Department of Medicine, Nephrology Section/MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Kristin Bergsland
- Department of Medicine, Nephrology Section/MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Fredric Coe
- Department of Medicine, Nephrology Section/MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Elaine Worcester
- Department of Medicine, Nephrology Section/MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Megan Prochaska
- Department of Medicine, Nephrology Section/MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA.
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19
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Hashmi S, Abid A, Sultan S, Shekhani SS, Lanewala AA, Zafar MN. Primary hyperoxaluria and genetic linkages: an insight into the disease burden from Pakistan. Urolithiasis 2022; 50:439-445. [PMID: 35678848 DOI: 10.1007/s00240-022-01338-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/25/2022] [Indexed: 11/26/2022]
Abstract
Autosomal recessive disorders are prevalent in Pakistan, a developing South Asian country where consanguineous marriages are common. This study seeks to determine the prevalence of monogenic causes in children presenting with nephrocalcinosis and nephrolithiasis at a dialysis and transplant center in Karachi, Pakistan. A retrospective analysis was conducted in children aged 1-18 years presenting with nephrocalcinosis, between 2010 and 2019. Demographic information, clinical profile, laboratory parameters and stone analysis were collected, on a pre-designed questionnaire. One hundred and twenty-six children were included, with 11 and 3 diagnosed with renal tubular acidosis and Bartter's syndrome respectively. Next-generation sequencing and Sanger sequencing was performed on 112 children. Eighty-seven patients were diagnosed with primary hyperoxaluria, with mutations in alanine-glyoxylate-aminotransferase gene found in 73, followed by glyoxylate reductase/hydroxy-pyruvate reductase in 13, and 4-hydroxy-2-oxaloglutarate aldolase in 1. Twenty-five patients reported negative for mutations. Sixty-four percent were males, with a statistically significant difference (p < 0.05). History of parental consanguineous marriage was found in 98% of the cohort. Fifty-four and 40 patients presented to the clinic with Chronic Kidney Disease Stage 1 and Stage 5, respectively, with a statistically significant difference p = 0.007. Mutations noted in our cohort are different and more severe than those reported in the developed world. The disease poses a major disease burden in developing world context with the only treatment option of combined liver-kidney transplantation not available in Pakistan.
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Affiliation(s)
- Seema Hashmi
- Department of Pediatric Nephrology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan.
| | - Aiysha Abid
- Department of Genetics, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Sajid Sultan
- Department of Pediatric Urology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Sualeha Siddiq Shekhani
- Centre of Biomedical Ethics and Culture, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Ali Asghar Lanewala
- Department of Pediatric Nephrology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Mirza Naqi Zafar
- Department of Pathology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
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Hiremath S, Viswanathan P. Oxalobacter formigenes: A new hope as a live biotherapeutic agent in the management of calcium oxalate renal stones. Anaerobe 2022; 75:102572. [PMID: 35443224 DOI: 10.1016/j.anaerobe.2022.102572] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 02/05/2023]
Abstract
Recent advances in understanding the association of gut microbiota with the host have shown evidence of certain bacterial therapeutic potentiality in preventing and treating metabolic diseases. Hyperoxaluria is a severe challenge in nephrology and has led to the novel gut eubiosis as current therapy. The human gut commensal, obligate anaerobic, and intestinal oxalate-degrading strains of Oxalobacter formigenes have drawn a promising significant interest for the next-generation probiotics (NGPs). This nonpathogenic, potential probiotic, and specialist oxalotrophic properties of O. formigenes give a new hope as a live biotherapeutic agent for calcium oxalate renal therapy. Numerous satisfactory outcomes of in vitro and in vivo studies were achieved on evaluating O. formigenes functionality, but the commercial production of this bacterium is yet to be achieved. This bacterium finds diverse application in dietary and endogenous oxalate degradation and the improvement of gut health, on which we concentrated our attention in this review. The relationship between good anaerobic gut bacterial dysbiosis and renal complications is comprehensively discussed to address the need for the development probiotic formulation. However, the commercial production of this bacteria on a broad scale is complex, with numerous obstacles, mainly because they are oxygen-sensitive and difficult to culture. This review will coherently present the current and available methodologies in producing, stabilizing, and delivering these NGPs to treat calcium stones. Moreover, the study presents the extensive work and key milestones achieved in the research on O. formigenes from tale to the truth.
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Affiliation(s)
- Shridhar Hiremath
- Renal Research Laboratory, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, 632 014, Tamil Nadu, India.
| | - Pragasam Viswanathan
- Renal Research Laboratory, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, 632 014, Tamil Nadu, India.
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21
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Cui X, Chen X, Li Y, Fu X, Song P, Xiao L, Sun L, Liu H, Zhu X, Yuan S. Oxalate crystal-related acute renal injury caused by orlistat: A case report. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2022; 47:583-587. [PMID: 35753728 PMCID: PMC10929923 DOI: 10.11817/j.issn.1672-7347.2022.210393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Indexed: 06/15/2023]
Abstract
We reported a case of oxalate crystal-related acute kidney injury caused by orlistat. The patient was admitted for nephrotic syndrome and acute kidney injury. The pathomorphological assessment of renal biopsy showed intratubular oxalate crystals. The patient reported that she had taken orlistat regularly to loss weight for more than a year. This patient had a habit of drinking vegetable soup and strong herbal tea daily. Orlistat, an intestinal lipase inhibitor, may cause secondary hyperoxaluria, that is, intestinal hyperoxaluria. Dietary habits could be a common precipitating factor for orlistat-relevant hyperoxaluria. It was comprehensively considered to be oxalate crystal-related acute renal injury, and the patient's renal function recovered gradually after drug withdrawal. Clinicians should pay attention to screening drug-related acute kidney injury including orlistat when observing patients with unexplained acute kidney injury, and renal biopsy should be performed if necessary. It is also important to warn people who take the orlistat for weight loss about the side effects of this drug so as to adjust the eating habits.
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Affiliation(s)
- Xinyuan Cui
- Department of Nephrology, Second Xiangya Hospital, Central South University; Institute of Nephrology, Central South University, Changsha 410011, China.
| | - Xiaojun Chen
- Department of Nephrology, Second Xiangya Hospital, Central South University; Institute of Nephrology, Central South University, Changsha 410011, China.
| | - Yifu Li
- Department of Nephrology, Second Xiangya Hospital, Central South University; Institute of Nephrology, Central South University, Changsha 410011, China
| | - Xiao Fu
- Department of Nephrology, Second Xiangya Hospital, Central South University; Institute of Nephrology, Central South University, Changsha 410011, China
| | - Pan'ai Song
- Department of Nephrology, Second Xiangya Hospital, Central South University; Institute of Nephrology, Central South University, Changsha 410011, China
| | - Li Xiao
- Department of Nephrology, Second Xiangya Hospital, Central South University; Institute of Nephrology, Central South University, Changsha 410011, China
| | - Lin Sun
- Department of Nephrology, Second Xiangya Hospital, Central South University; Institute of Nephrology, Central South University, Changsha 410011, China
| | - Hong Liu
- Department of Nephrology, Second Xiangya Hospital, Central South University; Institute of Nephrology, Central South University, Changsha 410011, China
| | - Xuejing Zhu
- Department of Nephrology, Second Xiangya Hospital, Central South University; Institute of Nephrology, Central South University, Changsha 410011, China.
| | - Shuguang Yuan
- Department of Nephrology, Second Xiangya Hospital, Central South University; Institute of Nephrology, Central South University, Changsha 410011, China.
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22
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Tarasewicz A, Laudańska E, Naumnik B. [Oxalobacter formigenes - use of the colon microbiome in the prevention of kidney stones]. Pol Merkur Lekarski 2022; 50:54-57. [PMID: 35278301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The number of calcium oxalate urolithiasis is increasing every year, especially in highly developed countries. The most common causes of precipitation are hyperoxaluria and hypercalciuria. The reason for increased oxalate excretion may be genetic defects of hepatic enzymes (primary hyperoxaluria), disturbances in metabolism or absorption of oxalate and changes in the composition of the intestinal microflora in the form of deficiency of oxalate metabolizing bacteria e.g. Oxalobacter formigenes. This bacterium has been the scientific focus of attention in recent years due to numerous reports on its impact on the reduction of oxaluria, resulting in a decreased recurrence risk of calcium oxalate stones by up to 70%. In recent years, attempts have been made to create a probiotic drug, the main element of which is O. formigenes.
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Affiliation(s)
- Artur Tarasewicz
- I Department of Nephrology and Transplantology with Dialysis Unit of Medical University of Białystok, Poland
| | - Elżbieta Laudańska
- I Department of Nephrology and Transplantology with Dialysis Unit of Medical University of Białystok, Poland
| | - Beata Naumnik
- I Department of Nephrology and Transplantology with Dialysis Unit of Medical University of Białystok, Poland
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23
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Verhulst A, Dehmel B, Lindner E, Akerman ME, D'Haese PC. Oxalobacter formigenes treatment confers protective effects in a rat model of primary hyperoxaluria by preventing renal calcium oxalate deposition. Urolithiasis 2022; 50:119-130. [PMID: 35122487 DOI: 10.1007/s00240-022-01310-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 01/21/2022] [Indexed: 01/25/2023]
Abstract
In primary hyperoxaluria, increased hepatic oxalate production sometimes leads to severe nephrocalcinosis and early end-stage kidney disease. Oral administration of Oxalobacter formigenes (O. formigenes), an oxalate-degrading bacterium, is thought to derive oxalate from systemic sources by inducing net enteric oxalate secretion. Here, the impact of O. formigenes on nephrocalcinosis was investigated in an ethylene glycol rat model mimicking hepatic oxalate overproduction in primary hyperoxaluria. Eighteen rats were administered ethylene glycol (0.75% in drinking water) for 6 weeks, of which 9 were treated by oral gavage with O. formigenes and 9 received vehicle. Five control rats did not receive ethylene glycol or O. formigenes. Plasma and urinary oxalate levels, calcium oxalate crystalluria, urinary volume, fluid intake, and serum creatinine were monitored during the study. On killing, nephrocalcinosis was quantified. Ethylene glycol intake induced pronounced hyperoxalemia, hyperoxaluria, calcium oxalate crystalluria and nephrocalcinosis. Concomitant O. formigenes treatment partially prevented the ethylene glycol-induced increase in plasma oxalate and completely prevented nephrocalcinosis. Urinary oxalate excretion was not reduced by O. formigenes treatment. Nevertheless, absence of crystals in renal tissue of O. formigenes-treated ethylene glycol animals indicates that the propensity for oxalate to crystallize in the kidneys was reduced compared to non-treated animals. This is supported by the lower plasma oxalate concentrations in O. formigenes-treated animals. This study shows a beneficial effect of O. formigenes treatment on ethylene glycol-induced hyperoxalemia and nephrocalcinosis, and thus supports a possible beneficial effect of O. formigenes in primary hyperoxaluria.
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Affiliation(s)
- A Verhulst
- Laboratory of Pathophysiology, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium.
| | | | | | | | - P C D'Haese
- Laboratory of Pathophysiology, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
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24
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Guzel A, Yunusoglu S, Calapoglu M, Candan IA, Onaran I, Oncu M, Ergun O, Oksay T. Protective Effects of Quercetin on Oxidative Stress-Induced Tubular Epithelial Damage in the Experimental Rat Hyperoxaluria Model. ACTA ACUST UNITED AC 2021; 57:medicina57060566. [PMID: 34204866 PMCID: PMC8228054 DOI: 10.3390/medicina57060566] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 02/05/2023]
Abstract
Background and Objectives: The most common kidney stones are calcium stones and calcium oxalate (CaOx) stones are the most common type of calcium stones. Hyperoxaluria is an essential risk factor for the formation of these stones. Quercetin is a polyphenol with antioxidant, anti-inflammatory, and many other physiological effects. The aim of this study was to investigate the protective effect of quercetin in hyperoxaluria-induced nephrolithiasis. Materials and Methods: Male Wistar-Albino rats weighing 250–300 g (n = 24) were randomized into three groups: Control (n = 8), ethylene glycol (EG) (n = 8), and EG + quercetin (n = 8). One percent EG-water solution was given to all rats except for the control group as drinking water for five weeks. Quercetin-water solution was given to the EG + quercetin group by oral gavage at a dose of 10 mg/kg/day. Malondialdehyde (MDA), catalase (CAT), urea, calcium, and oxalate levels were analyzed in blood and urine samples. Histopathological assessments and immunohistochemical analyses for oxidative stress and inflammation indicators p38 mitogen-activated protein kinase (p38-MAPK) and nuclear factor kappa B (NF-kB) were performed on renal tissues. Results: The MDA levels were significantly lower in the quercetin-treated group than in the EG-treated group (p = 0.001). Although CAT levels were higher in the quercetin-treated group than the EG-administered group, they were not significantly different between these groups. The expression of p38 MAPK was significantly less in the quercetin-treated group than the EG group (p < 0.004). There was no statistically significant difference between the quercetin and EG groups in terms of NF-kB expression. Conclusions: We conclude that hyperoxaluria activated the signaling pathways, which facilitate the oxidative processes leading to oxalate stone formation in the kidneys. Our findings indicated that quercetin reduced damage due to hyperoxaluria. These results imply that quercetin can be considered a therapeutic agent for decreasing oxalate stone formation, especially in patients with recurrent stones due to hyperoxaluria.
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Affiliation(s)
- Ahmet Guzel
- Department of Urology, Aydın State Hospital, Aydın 09100, Turkey
- Correspondence: ; Tel.: +90-505-303-94-14
| | - Sedat Yunusoglu
- Department of Urology, Afyonkarahisar State Hospital, Afyonkarahisar 03100, Turkey;
| | - Mustafa Calapoglu
- Department of Biochemistry, Faculty of Arts and Science, Suleyman Demirel University, Isparta 32100, Turkey;
| | - Ibrahim Aydın Candan
- Department of Histology and Embryology, Faculty of Medicine, Alanya Alaaddin Keykubat University, Antalya 07100, Turkey;
| | - Ibrahim Onaran
- Department of Medical Biology, Faculty of Medicine, Suleyman Demirel University, Isparta 32100, Turkey;
| | - Meral Oncu
- Department of Histology and Embryology, Faculty of Medicine, Suleyman Demirel University, Isparta 32100, Turkey;
| | - Osman Ergun
- Department of Urology, Faculty of Medicine, Suleyman Demirel University, Isparta 32100, Turkey; (O.E.); (T.O.)
| | - Taylan Oksay
- Department of Urology, Faculty of Medicine, Suleyman Demirel University, Isparta 32100, Turkey; (O.E.); (T.O.)
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Rendina D, De Filippo G, Merlotti D, Di Stefano M, Mingiano C, Giaquinto A, Evangelista M, Bo M, Arpino S, Faraonio R, Strazzullo P, Gennari L. Increased Prevalence of Nephrolithiasis and Hyperoxaluria in Paget Disease of Bone. J Clin Endocrinol Metab 2020; 105:5896000. [PMID: 32827434 DOI: 10.1210/clinem/dgaa576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 08/20/2020] [Indexed: 12/11/2022]
Abstract
CONTEXT Nephrolithiasis (NL) and primary hyperparathyroidism (HPTH) are metabolic complications of Paget disease of bone (PDB), but recent data regarding their prevalence in PDB patients are lacking. OBJECTIVES Study 1: To compare the prevalence of primary HPTH and NL in 708 patients with PDB and in 1803 controls. Study 2: To evaluate the prevalence of NL-metabolic risk factors in 97 patients with PDB and NL, 219 PDB patients without NL, 364 NL patients without PDB, and 219 controls, all of them without HPTH. DESIGN Cross-sectional multicentric study. SETTING Italian referral centers for metabolic bone disorders. PARTICIPANTS Patients with PDB from the Associazione Italiana malati di osteodistrofia di Paget registry. Participants in the Olivetti Heart and the Siena Osteoporosis studies. MAIN OUTCOME MEASURES HPTH; NL; NL-metabolic risk factors. RESULTS Patients with PDB showed higher prevalence of primary HPTH and NL compared with controls (P < 0.01). The NL recurrence occurs more frequently in patients with polyostotic PDB. About one-half of patients with PDB but without NL showed 1 or more NL-related metabolic risk factors. The hyperoxaluria (HyperOx) prevalence was higher in patients with PDB and NL compared with patients with NL but without PDB and in patients with PDB without NL compared with controls (P = 0.01). Patients with PDB and HyperOx showed a longer lapse of time from the last aminobisphosphonate treatment. CONCLUSIONS NL and HPTH are frequent metabolic complication of PDB. The NL occurrence should be evaluated in patients with PDB, particularly in those with polyostotic disease and/or after aminobisphosphonate treatment to apply an adequate prevention strategy.
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Affiliation(s)
- Domenico Rendina
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Gianpaolo De Filippo
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert-Debré, Service d'Endocrinologie et Diabétologie Pédiatrique, Paris, France
| | - Daniela Merlotti
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Marco Di Stefano
- Department of Medical Science, Gerontology and Bone Metabolic Diseases, University of Torino, Torino, Italy
| | - Christian Mingiano
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Alfonso Giaquinto
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Marco Evangelista
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Mario Bo
- Department of Medical Science, Gerontology and Bone Metabolic Diseases, University of Torino, Torino, Italy
| | - Sergio Arpino
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy
| | - Raffaella Faraonio
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy
| | - Pasquale Strazzullo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Luigi Gennari
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
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26
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Narula S, Tandon S, Kumar D, Varshney S, Adlakha K, Sengupta S, Singh SK, Tandon C. Human kidney stone matrix proteins alleviate hyperoxaluria induced renal stress by targeting cell-crystal interactions. Life Sci 2020; 262:118498. [PMID: 32991878 DOI: 10.1016/j.lfs.2020.118498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 09/10/2020] [Accepted: 09/20/2020] [Indexed: 12/19/2022]
Abstract
Increased levels of urinary oxalate also known as hyperoxaluria, increase the likelihood of kidney stone formation through enhanced calcium oxalate (CaOx) crystallization. The management of lithiatic renal pathology requires investigations at the initial macromolecular stages. Hence, the current study was designed to unravel the protein make-up of human kidney stones and its impact on renal cells' altered proteome, induced as the consequence of CaOx injury. CaOx kidney stones were collected from patients; stones were pooled for entire cohort, followed by protein extraction. Immunocytochemistry, RT-PCR and flow-cytometric analysis revealed the promising antilithiatic activity of kidney stone matrix proteins. The iTRAQ analysis of renal cells showed up-regulation of 12 proteins and down-regulation of 41 proteins due to CaOx insult, however, this differential expression was normalized in the presence of kidney stone matrix proteins. Protein network analysis revealed involvement of up-regulated proteins in apoptosis, calcium-binding, inflammatory and stress response pathways. Moreover, seven novel antilithiatic proteins were identified from human kidney stones' matrix: Tenascin-X-isoform2, CCDC-144A, LIM domain kinase-1, Serine/Arginine receptor matrix protein-2, mitochondrial peptide methionine sulfoxide reductase, volume-regulated anion channel subunit-LRRC8A and BMPR2. In silico analysis concluded that these proteins exert antilithiatic potential through crystal binding, thereby inhibiting the crystal-cell interaction, a pre-requisite to initiate inflammatory response. Thus, the outcomes of this study provide insights into the molecular events of CaOx induced renal toxicity and subsequent progression into nephrolithiasis.
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Affiliation(s)
- Shifa Narula
- Amity Institute of Biotechnology (AIB), Amity University, Noida, Uttar Pradesh 201301, India
| | - Simran Tandon
- Amity Institute of Molecular Medicine and Stem Cell Research (AIMMSCR), Amity University, Noida, Uttar Pradesh 201301, India
| | - Dhruv Kumar
- Amity Institute of Molecular Medicine and Stem Cell Research (AIMMSCR), Amity University, Noida, Uttar Pradesh 201301, India
| | - Swati Varshney
- Genomics and Molecular Medicine, Council of Scientific and Industrial Research (CSIR)-Institute of Genomics and Integrative Biology, Mathura Road, New Delhi, India
| | - Khushboo Adlakha
- Genomics and Molecular Medicine, Council of Scientific and Industrial Research (CSIR)-Institute of Genomics and Integrative Biology, Mathura Road, New Delhi, India
| | - Shantanu Sengupta
- Genomics and Molecular Medicine, Council of Scientific and Industrial Research (CSIR)-Institute of Genomics and Integrative Biology, Mathura Road, New Delhi, India
| | - Shrawan Kumar Singh
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Chanderdeep Tandon
- Amity Institute of Biotechnology (AIB), Amity University, Noida, Uttar Pradesh 201301, India.
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27
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Heron VC, Kerr PG, Kanellis J, Polkinghorne KR, Isbel NM, See EJ. Long-Term Graft and Patient Outcomes Following Kidney Transplantation in End-Stage Kidney Disease Secondary to Hyperoxaluria. Transplant Proc 2020; 53:839-847. [PMID: 32980135 DOI: 10.1016/j.transproceed.2020.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 08/08/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND End-stage kidney disease secondary to hyperoxaluria presents a major challenge for transplant physicians given concern regarding disease recurrence. Few contemporary studies have reported long-term outcomes following transplantation in this population. METHODS This study examined the outcomes of all adult patients with end-stage kidney disease secondary to hyperoxaluria who received a kidney or combined liver-kidney transplant in Australia and New Zealand between 1965 and 2015. Patients with hyperoxaluria were propensity score matched to control patients with reflux nephropathy. The primary outcome was graft survival. Secondary outcomes included graft function, acute rejection, and patient survival. RESULTS Nineteen transplants performed in 16 patients with hyperoxaluria were matched to 57 transplants in patients with reflux nephropathy. Graft survival was inferior in patients with hyperoxaluria receiving a kidney transplant alone (subhazard ratio [SHR] = 3.83, 95% confidence interval [CI], 1.22-12.08, P = .02) but not in those receiving a combined liver-kidney transplant (SHR = 0.63, 95% CI, 0.08-5.21, P = .67). Graft failure risk was particularly high in patients with hyperoxaluria receiving a kidney transplant alone after more than 1 year of renal replacement therapy (SHR = 8.90, 95% CI, 2.35-33.76, P = .001). Posttransplant estimated glomerular filtration rate was lower in patients with hyperoxaluria (10.97 mL/min/1.73 m2, 95% CI, 0.53-21.42, P = .04). There was no difference between groups in the risk of acute rejection or death with a functioning graft. CONCLUSION Compared to reflux nephropathy, hyperoxaluria was associated with inferior graft survival in patients receiving a kidney transplant alone. Long-term graft function was lower in patients with hyperoxaluria, but the risks of acute rejection and death were not different.
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Affiliation(s)
- Vanessa C Heron
- Department of Nephrology, Austin Health, Heidelberg, Victoria, Australia; Department of Nephrology, Monash Health, Clayton, Victoria, Australia.
| | - Peter G Kerr
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia
| | - John Kanellis
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia; Center for Inflammatory Diseases, Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Kevan R Polkinghorne
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia; Department of Epidemiology and Preventative Medicine, Monash University, Clayton, Victoria, Australia
| | - Nikky M Isbel
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Emily J See
- School of Medicine, University of Melbourne, Parkville, Victoria, Australia; Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
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28
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Choi EJ, Chee CG, Kim W, Song JS, Chung HW. Bone oxaloma-a localized manifestation of bone oxalosis. Skeletal Radiol 2020; 49:651-655. [PMID: 31768582 DOI: 10.1007/s00256-019-03348-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/09/2019] [Accepted: 11/12/2019] [Indexed: 02/02/2023]
Abstract
Oxalosis is a metabolic disorder characterized by the accumulation of calcium oxalate deposits in various organ systems. Bone oxalosis is a systemic manifestation of oxalosis, in which calcium oxalate deposits accumulate in the skeletal system. This report describes a 69-year-old female patient who presented with right hip pain and was later found to have an osseous mass-like lesion in the right proximal femur, with radiographic findings resembling those of a benign bone tumor. CT-guided biopsy and surgical biopsy showed that the mass had pathologic findings typical of bone oxalosis. Because the patient had no predisposing factors for systemic oxalosis and had no hyperoxalemia or hyperoxaluria, she could be diagnosed with localized bone oxalate deposition disease or bone oxaloma rather than bone oxalosis. This is the first report of this clinical entity to present as a benign-appearing bone mass and without any predisposing systemic causes.
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Affiliation(s)
- Eun Ji Choi
- Department of Radiology, Asan Medical Center, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Choong Guen Chee
- Department of Radiology, Asan Medical Center, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Wanlim Kim
- Department of Orthopedic Surgery, Asan Medical Center, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Joon Seon Song
- Department of Pathology, Asan Medical Center, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Hye Won Chung
- Department of Radiology, Asan Medical Center, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul, 05505, Republic of Korea
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29
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Affiliation(s)
- James Forryan
- From Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Vinita Mishra
- From Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Emily Gibbons
- From Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
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30
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de Martines DGL, Gianotten S, F M Wetzels J, G van der Meijden WA. Secondary hyperoxaluria due to pancreatic insufficiency. Neth J Med 2019; 77:287-292. [PMID: 31814577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND In this article, we present two cases of patients with acute renal insufficiency with a history of exocrine pancreatic insufficiency. In one case, this was caused by pancreaticoduodenectomy; in the other, by alcohol abuse. Neither patient had considerable proteinuria or haematuria. Their renal biopsies showed tubulopathy with widespread oxalate crystals, characterised by their birefringence in light microscopy. Restricting oxalate intake and prescribing oxalate binding agents reduced serum oxalate levels. Renal function partially recovered in both patients. Oxalate nephropathy is associated with exocrine pancreatic insufficiency, gastric and pancreatic surgery, and inflammatory bowel disease. Normally, dietary calcium binds oxalate to form calcium oxalate, which is excreted in the stool. In patients with pancreatic insufficiency, fatty acids bind calcium instead, allowing oxalate to be absorbed in the colon. The resulting hyperoxaluria can cause oxalate crystal formation, tubulopathy, and renal insufficiency. Treatment relies on decreasing the amount of absorbable oxalate in the intestinal lumen, as well as lowering urinary oxalate concentrations. CONCLUSION Secondary hyperoxaluria is a common cause of renal insufficiency and should be considered in patients with a medical history of pancreatic insufficiency and progressive kidney injury.
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Affiliation(s)
- D G L de Martines
- Department of Nephrology, Radboud University Medical Centre, Nijmegen, the Netherlands
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31
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Lingeman JE, Pareek G, Easter L, Pease R, Grujic D, Brettman L, Langman CB. ALLN-177, oral enzyme therapy for hyperoxaluria. Int Urol Nephrol 2019; 51:601-608. [PMID: 30783888 PMCID: PMC6459785 DOI: 10.1007/s11255-019-02098-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/04/2019] [Indexed: 11/25/2022]
Abstract
Purpose To evaluate the potential of ALLN-177, an orally administered, oxalate-specific enzyme therapy to reduce urine oxalate (UOx) excretion in patients with secondary hyperoxaluria. Methods Sixteen male and female subjects with both hyperoxaluria and a kidney stone history were enrolled in an open-label study. Subjects continued their usual diets and therapies. During a 3-day baseline period, two 24-h (24-h) urines were collected, followed by a 4-day treatment period with ALLN-177 (7,500 units/meal, 3 × day) when three 24-h urines were collected. The primary endpoint was the change in mean 24-h UOx from baseline. Safety assessments and 24-h dietary recalls were performed throughout. Results The study enrolled 5 subjects with enteric hyperoxaluria and 11 with idiopathic hyperoxaluria. ALLN-177 was well tolerated. Overall mean (SD) UOx decreased from 77.7 (55.9) at baseline to 63.7 (40.1) mg/24 h while on ALLN-177 therapy, with the mean reduction of 14 mg/24 h, (95% CI − 23.71, − 4.13). The calcium oxalate-relative urinary supersaturation ratio in the overall population decreased from a mean of 11.3 (5.7) to 8.8 (3.8) (− 2.8; 95% CI − 4.9, − 0.79). This difference was driven by oxalate reduction alone, but not any other urinary parameters. Mean daily dietary oxalate, calcium, and fluid intake recorded by frequent diet recall did not differ by study periods. Conclusion ALLN-177 reduced 24-h UOx excretion, and was well tolerated. The results of this pilot study provided justification for further investigation of ALLN-177 in patients with secondary hyperoxaluria. Trial registration: Clinicaltrials.gov NCT02289755.
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Affiliation(s)
- James E Lingeman
- Department of Urology, Indiana University School of Medicine, 1801 N Senate Blvd #220, Indianapolis, IN, 46202, USA
| | - Gyan Pareek
- Division of Urology, The Warren Alpert Medical School of Brown University, 2 Dudley Street Suite 174, Providence, RI, 02905, USA
| | - Linda Easter
- Clinical and Translational Science Institute, Wake Forest University School of Medicine, 1st Floor, Meads Hall, 1 Medical Center Boulevard, Winston-Salem, NC, 27106, USA
| | - Rita Pease
- Allena Pharmaceuticals, One Newton Executive Park, Suite 202, Newton, MA, 02462, USA
| | - Danica Grujic
- Allena Pharmaceuticals, One Newton Executive Park, Suite 202, Newton, MA, 02462, USA
| | - Lee Brettman
- Allena Pharmaceuticals, One Newton Executive Park, Suite 202, Newton, MA, 02462, USA
| | - Craig B Langman
- Feinberg School of Medicine, Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Avenue, Chicago, IL, 60611, USA.
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Affiliation(s)
- S A Boddy
- Department of Urology, St Bartholomew's Hospital, London
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Kitajima K, Ogawa Y, Miki K, Kai K, Sannomiya A, Iwadoh K, Murakami T, Koyama I, Nakajima I, Fuchinoue S. Longterm renal allograft survival after sequential liver-kidney transplantation from a single living donor. Liver Transpl 2017; 23:315-323. [PMID: 27862900 DOI: 10.1002/lt.24676] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 11/03/2016] [Indexed: 12/31/2022]
Abstract
Combined liver-kidney transplantation (CLKT) is well established as a definitive therapy with the potential to provide complete recovery for certain liver-kidney diseases, although the results might be contingent on the cause of transplantation. The purposes of the present study were to review the longterm outcome of renal allografts in CLKT patients from single living donors and to investigate the beneficial factors, compared with solitary renal transplantation. Thirteen patients underwent sequential liver transplantation (LT) and kidney transplantation (KT) from single living donors. The indications for KT were oxaluria (n = 7), autosomal recessive polycystic disease (n = 3), and others (n = 3). The same immunosuppressive regimen used after LT was also used after KT. KT was performed between 1.7 and 47.0 months after the LT. The overall patient survival rate was 92.3% at 10 years. In 12 of the 13 surviving patients, the renal allografts were found to be functioning in 11 patients after a mean follow-up period of 103.6 months. The death-censored renal allograft survival rate at 10 years was 100%, which was better than that of KT alone (84.9%) in Japan. Immunological protection conferred by the preceding liver allograft may have contributed to the longterm outcomes of the renal allografts. In addition, the donation of double organs from a single living and related donor may have a favorable impact on the graft survival rate. In the future, investigations of factors affecting the longterm outcome of renal allografts, including details of the involvement of de novo donor-specific antibody, will be needed. Liver Transplantation 23 315-323 2017 AASLD.
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Affiliation(s)
- Kumiko Kitajima
- Department of Surgery, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuichi Ogawa
- Department of Surgery, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Katsuyuki Miki
- Department of Surgery, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Kotaro Kai
- Department of Surgery, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Akihito Sannomiya
- Department of Surgery, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuhiro Iwadoh
- Department of Surgery, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Toru Murakami
- Department of Surgery, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Ichiro Koyama
- Department of Surgery, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Ichiro Nakajima
- Department of Surgery, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Shohei Fuchinoue
- Department of Surgery, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
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Lancina Martín JA. [Metabolic study. How to make it accessible, useful and generalized.]. ARCH ESP UROL 2017; 70:71-90. [PMID: 28221143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Risk factors should be evaluated in all patients with urinary lithiasis. The kind of evaluation, simplified or extended, depends on stone composition and, in patients with calcium lithiasis, on the clinical presentation. These studies are done in an outpatient regimen, are easy to perform and accessible for most laboratories. Patients with uric acid, infectious and cystine stones only require a selective more abbreviated evaluation. In calcium lithiasis we perform an extended metabolic evaluation in recurrent patients and also in singleepisode patients when they have high recurrence risk. The extended evaluation has demonstrated to be costeffective in patients with highly recurrent lithiasis. There is not enough clinical evidence yet on what would be the most convenient study methodology for a proper metabolic evaluation, and proposed clinical guidelines are mainly based on expert committee opinions.With these studies, we can diagnose systemic and renal diseases of lithogenic nature, and they also enable the adoption of precise prophylactic measures that achieve recurrence control in a great number of patients.
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Arrabal-Martín M, Cano-García MC, Arrabal-Polo MÁ, Domínguez-Amillo A, Canales-Casco N, de la Torre-Trillo J, Cózar-Olmo JM. [Etiopathogenic factors of the different types of urinary litiasis.]. ARCH ESP UROL 2017; 70:40-50. [PMID: 28221141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In this review, we analyze the etiopathogenic principles of urinary lithiasis formation. In the kidney, calcifications that may cause renal lithiasis are produced as a consequence of processes that injury the urothelium at the papilla and Bellini's ducts. With the improvement of imaging techniques, mainly micro CT scan, it is possible to detect them and we may be able to anticipate to the formation of lithiasis. As we well know, there are different factors that influence the formation of the calculi depending on their composition. In calcium lithiasis it is key to review the modification of the categories of hypercalciuria, we currently distinguish two types instead of three, thanks to the fasting calcium/ creatinine ratio, differentiating absorptive hypercalciuria and fasting hypercalciuria. In the fasting hypercalciuria, it is important to emphasize the relationship between this factor and the loss of bone mineral density in patients with recurrent renal calcic lithiasis, so that in this kind of patients it is compulsory the study of bone metabolism by bone remodelling markers and bone densitometry. Regarding the other factors that participate in the formation of calcium lithiasis we should specially emphasize on hypercalciuria and its growing increase because of its relationship with obesity and metabolic syndrome, as well as hipocitraturia, present in an important percentage of patients and related in some cases with metabolic acidosis and osteopenia-osteoporosis too. In relation to uric acid lithiasis it should be highlighted that urinary pH is the most determinant factor and, therefore, its control and modifications would be paramount for prevention of this type of lithiasis. In the infectious lithiasis, the presence of germs that split urea is mandatory. They generate ammonia ions with the ability to injure the urothelium and to form magnesium ammonium phosphate lithiasis mainly. Regarding cystine lithiasis, rare, it was classically divided in three types and now passed to be classified in type A and B depending on the muted gene, and it is more useful to perform direct 24-hour urine measurement than screening tests which have low sensitivity. In general, we tried to give a comprehensive view of the various types of lithiasis emphasizing the most interesting clinical points for the urologist.
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Affiliation(s)
- Miguel Arrabal-Martín
- Unidad de Urolitiasis y Endourología. Servicio de Urología. Complejo Hospitalario Universitario Granada. España
| | - María Carmen Cano-García
- Unidad de Urolitiasis y Endourología. Servicio de Urología. Complejo Hospitalario Universitario Granada. España
| | - Miguel Ángel Arrabal-Polo
- Unidad de Urolitiasis y Endourología. Servicio de Urología. Complejo Hospitalario Universitario Granada. España
| | - Alejandro Domínguez-Amillo
- Unidad de Urolitiasis y Endourología. Servicio de Urología. Complejo Hospitalario Universitario Granada. España
| | - Nelson Canales-Casco
- Unidad de Urolitiasis y Endourología. Servicio de Urología. Complejo Hospitalario Universitario Granada. España
| | - Javier de la Torre-Trillo
- Unidad de Urolitiasis y Endourología. Servicio de Urología. Complejo Hospitalario Universitario Granada. España
| | - José Manuel Cózar-Olmo
- Unidad de Urolitiasis y Endourología. Servicio de Urología. Complejo Hospitalario Universitario Granada. España
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Ekser B, Mangus RS, Kubal CA, Fridell JA, Powelson JA, Nagaraju S, Mihaylov P, Phillips CL, Saxena R, Goggins WC. Recurrence of Hyperoxaluria and Kidney Disease after Combined Intestine-Kidney Transplantation for Enteric Hyperoxaluria. Am J Nephrol 2016; 44:85-91. [PMID: 27410399 DOI: 10.1159/000447785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/09/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Enteric hyperoxaluria (EH) occurs with a rate of 5-24% in patients with inflammatory bowel disease, ileal resection and modern bariatric surgery. The excessive absorption of calcium oxalate causes chronic kidney disease (CKD) in patients with EH. In the literature, a single experience was reported in combined intestine-kidney transplantation (CIKTx) in patients with CKD due to EH. METHODS After a report of 2 successful cases of CIKTx in patients with EH and CKD, one was performed at our center in a 59-year-old Caucasian female who developed intestinal failure with total parenteral nutrition (TPN) dependence after a complication post-bariatric surgery. Before CIKTx, she underwent kidney transplantation alone (KTA) twice, which failed due to oxalate nephropathy. RESULTS In July 2014, the patient underwent CIKTx and bilateral allograft nephrectomy to avoid EH and oxalate stone burden. The postoperative course was complicated with acute tubular necrosis due to the use of high pressors related to perioperative bleeding. The patient was discharged 79 days after CIKTx with a serum creatinine (sCr) of 1.2 mg/dl and free of TPN. Her sCr increased at 7 months and a renal biopsy showed oxalate nephropathy. SLC26A6 (oxalate transporter) staining was significantly diminished in native duodenum/rectum as well as in intestinal allograft compared to control. CONCLUSIONS KTA in patients with CKD secondary to EH should not be recommended due to high risk of recurrence. Although other centers showed good long-term outcomes in CIKTx, our patient experienced recurrence of EH due to oxalate transporter defect, early kidney allograft dysfunction and prolonged antibiotic use.
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Affiliation(s)
- Burcin Ekser
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind., USA
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Cao Y, Liu W, Hui L, Zhao J, Yang X, Wang Y, Niu H. Renal tubular injury induced by ischemia promotes the formation of calcium oxalate crystals in rats with hyperoxaluria. Urolithiasis 2016; 44:389-97. [PMID: 27040948 DOI: 10.1007/s00240-016-0876-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 03/22/2016] [Indexed: 11/25/2022]
Abstract
Hyperoxaluria and cell injury are key factors in urolithiasis. Oxalate metabolism may be altered by renal dysfunction and therefore, impact the deposition of calcium oxalate (CaOx) crystals. We investigated the relationship of renal function, oxalate metabolism and CaOx crystal deposition in renal ischemia. One hundred male Sprague-Dawley rats were randomly divided into four groups. Hyperoxaluria model (Group A and B) was established by feeding rats with 0.75 % ethylene glycol (EG). The left renal pedicle was clamped for 30 min to establish renal ischemia Groups (B and C), while Groups A and D underwent sham operation. Then, serum and urine oxalate (Ox), creatinine (Cr) and urea nitrogen (UN) levels were evaluated by liquid chromatography mass spectrometry (LCMS) and ion mass spectrum (IMS) at days 0, 2, 4, 7, and 14. CaOx crystallization was assessed by transmission electron microscope (TEM). A temporal and significant increase of serum Cr and UN levels was observed in Groups B and C compared to values obtained for Groups A and D (P < 0.05). Ox levels in serum and urine were significantly higher in Groups A and B than in the other two groups from day 7 (P < 0.05). In addition, CaOx crystallization was observed in both Groups A and B, but Group B showed earlier and more pronounced crystal deposition in the renal tissue. Our results indicated that renal tubular injury induced by renal ischemia might not affect Ox levels but could promote CaOx crystal retention under hyperoxaluria.
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Affiliation(s)
- Yanwei Cao
- Department of Urology, The Affiliated Hospital of Qingdao University, Haier Road No. 59, Qingdao, 266101, Shandong Province, People's Republic of China
| | - Wanpeng Liu
- Department of Urology, The First Affiliated Hospital of Harbin Medical University, Youzheng Street No. 23, Harbin, 150001, Heilongjiang, People's Republic of China
| | - Limei Hui
- Department of Urology, Affiliated Hospital of Hebei University of Engineering, Congtai Road No. 81, Handan, 056002, Hebei Province, People's Republic of China
| | - Jianjun Zhao
- Department of Urology, Affiliated Hospital of Hebei University of Engineering, Congtai Road No. 81, Handan, 056002, Hebei Province, People's Republic of China
| | - Xuecheng Yang
- Department of Urology, The Affiliated Hospital of Qingdao University, Haier Road No. 59, Qingdao, 266101, Shandong Province, People's Republic of China
| | - Yonghua Wang
- Department of Urology, The Affiliated Hospital of Qingdao University, Haier Road No. 59, Qingdao, 266101, Shandong Province, People's Republic of China
| | - Haitao Niu
- Department of Urology, The Affiliated Hospital of Qingdao University, Haier Road No. 59, Qingdao, 266101, Shandong Province, People's Republic of China.
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Ustinova EE, Malov VI, Lareva NV. [A rare case of oxalate nephropathy with acute renal injury]. Klin Med (Mosk) 2016; 94:467-469. [PMID: 30289667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE This case demonstrates the difficulty of diagnostics of oxalate nephropathy and possibility of development of acute kidney injury. SUMMARY The paper describes a patient with oxalate nephropathy and acute kidney injury. Specific features of oxalate diathesis are discussed as well as approaches to its diagnosis. Clinical peculiarities and diagnostic difficulties are described. CONCLUSIONS Early diagnosis of oxalate nephropathy and treatment permits to improve prognosis.
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Arrabal-Polo MA, Cano-Garcia MDC, Arrabal-Martin M. Lithogenic activity as a factor to consider in the metabolic evaluation of patients with calcium lithiasis. Iran J Kidney Dis 2015; 9:469-471. [PMID: 26552354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 08/17/2015] [Indexed: 06/05/2023]
Abstract
Metabolic evaluation is important in high-risk patients with a history of urinary calculi, in order to prevent recurrence. This study aimed to compare patients with calcium calculi and mild lithogenic activity with those with moderate to severe lithogenic activity. Patients with moderate to severe activity had higher levels of urinary calcium level (271.9 mg/24h versus 172.1 mg/24 h, P < .001), uric acid (612.3 mg/24 h versus 528.9 mg/24h, P = .008), and fasting calcium-creatinine ratio (0.16 versus 0.12, P = .001) compared to those with mild lithogenic activity. No association was observed between lithogenic factors in 24-hour urine and mild lithogenic activity in multivariable analysis. We initially thought that in patients who develop recurrent calculi after 5 years or who have mild lithogenic activity, complete metabolic evaluation would not be necessary. However, based on our study findings, it may be important to conduct further studies assessing the lithogenic activity.
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Ferraro PM, Robertson WG, Johri N, Nair A, Gambaro G, Shavit L, Moochhala SH, Unwin RJ. A London experience 1995-2012: demographic, dietary and biochemical characteristics of a large adult cohort of patients with renal stone disease. QJM 2015; 108:561-8. [PMID: 25524906 DOI: 10.1093/qjmed/hcu251] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Kidney stone disease has an estimated prevalence of around 10%. Genetic as well as environmental factors are thought to play an important role in the pathogenesis of renal stones. AIM The aim of our study was to analyse and report the main characteristics of patients with kidney stones attending a large UK metabolic stone clinic in London between 1995 and 2012. DESIGN A cross-sectional study. METHODS Analysis of data from stone formers attending the University College and Royal Free Hospitals' metabolic stone clinic from 1995 to 2012. Demographic, clinical, dietary and biochemical characteristics have been summarized and analysed for men and women separately; trends over time have also been analysed. RESULTS Of the 2861 patients included in the analysis, 2016 (70%) were men with an average age of 47 years (range 18-87 years) and median duration of disease of 6 years (range 0-60 years). The prevalence of low urine volume, hypercalciuria, hyperoxaluria, hyperuricosuria and hypocitraturia was 5.6%, 38%, 7.9%, 18% and 23%, respectively. The prevalence of several risk factors for stones increased over time. The majority of stones were mixed, with around 90% composed of calcium salts in varying proportion. CONCLUSION Our findings in a large cohort of patients attending a London-based stone clinic over the past 20 years show differences in distributions of risk factors for stones for men and women, as well as metabolic profiles and stone composition. The impact of most risk factors for stones appeared to change over time.
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Affiliation(s)
- P M Ferraro
- From the UCL Centre for Nephrology, Royal Free Hospital, London, UK, Division of Nephrology, Catholic University of the Sacred Heart, Rome, Italy, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK and Adult Nephrology Unit, Shaare Zedek Medical Center, Jerusalem, Israel From the UCL Centre for Nephrology, Royal Free Hospital, London, UK, Division of Nephrology, Catholic University of the Sacred Heart, Rome, Italy, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK and Adult Nephrology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - W G Robertson
- From the UCL Centre for Nephrology, Royal Free Hospital, London, UK, Division of Nephrology, Catholic University of the Sacred Heart, Rome, Italy, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK and Adult Nephrology Unit, Shaare Zedek Medical Center, Jerusalem, Israel From the UCL Centre for Nephrology, Royal Free Hospital, London, UK, Division of Nephrology, Catholic University of the Sacred Heart, Rome, Italy, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK and Adult Nephrology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - N Johri
- From the UCL Centre for Nephrology, Royal Free Hospital, London, UK, Division of Nephrology, Catholic University of the Sacred Heart, Rome, Italy, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK and Adult Nephrology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - A Nair
- From the UCL Centre for Nephrology, Royal Free Hospital, London, UK, Division of Nephrology, Catholic University of the Sacred Heart, Rome, Italy, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK and Adult Nephrology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - G Gambaro
- From the UCL Centre for Nephrology, Royal Free Hospital, London, UK, Division of Nephrology, Catholic University of the Sacred Heart, Rome, Italy, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK and Adult Nephrology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - L Shavit
- From the UCL Centre for Nephrology, Royal Free Hospital, London, UK, Division of Nephrology, Catholic University of the Sacred Heart, Rome, Italy, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK and Adult Nephrology Unit, Shaare Zedek Medical Center, Jerusalem, Israel From the UCL Centre for Nephrology, Royal Free Hospital, London, UK, Division of Nephrology, Catholic University of the Sacred Heart, Rome, Italy, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK and Adult Nephrology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - S H Moochhala
- From the UCL Centre for Nephrology, Royal Free Hospital, London, UK, Division of Nephrology, Catholic University of the Sacred Heart, Rome, Italy, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK and Adult Nephrology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - R J Unwin
- From the UCL Centre for Nephrology, Royal Free Hospital, London, UK, Division of Nephrology, Catholic University of the Sacred Heart, Rome, Italy, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK and Adult Nephrology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
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De Ferrari ME, Colussi G, Benazzi E, Rombolà G, Surian M, Malberti F, Brenna S, Minetti L. Calcium nephrolithiasis and renal tubular hypouricemia. Contrib Nephrol 2015; 58:41-3. [PMID: 3691146 DOI: 10.1159/000414485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Lu Y, Bonny O. [Oxalate: a poorly soluble organic waste with consequences]. Praxis (Bern 1994) 2015; 104:353-359. [PMID: 25804778 DOI: 10.1024/1661-8157/a001966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Oxalate is a highly insoluble metabolic waste excreted by the kidneys. Disturbances of oxalate metabolism are encountered in enteric hyperoxaluria (secondary to malabsorption, gastric bypass or in case of insufficient Oxalobacter colonization), in hereditary hyperoxaluria and in intoxication (ethylene glycol, vitamin C). Hyperoxaluria causes a large spectrum of diseases, from isolated hyperoxaluria to kidney stones and nephrocalcinosis formation, eventually leading to kidney failure and systemic oxalosis with life-threatening deposits in vital organs. New causes of hyperoxaluria are arising recently, in particular after gastric bypass surgery, which requires regular and preemptive monitoring. The treatment of hyperoxaluria involves reduction in oxalate intake and increase in calcium intake. Optimal urine dilution and supplementation with inhibitors of kidney stone formation (citrate) are required. Some conditions may need vitamin B6 supplementation, and the addition of probiotics might be useful in the future. Primary care physicians should identify cases of recurrent calcium oxalate stones and severe hyperoxaluria. Further management of hyperoxaluria requires specialized care.
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Affiliation(s)
- Yimin Lu
- Service de Néphrologie et d'Hypertension, Centre Hospitalier Universitaire Vaudois, Lausanne
| | - Olivier Bonny
- Service de Néphrologie et d'Hypertension, Centre Hospitalier Universitaire Vaudois, Lausanne und Département de Pharmacologie et de Toxicologie, Université de Lausanne
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Muji A, Moll S, Saudan P. [Oxalate nephropathy: a new entity of acute kidney injury in diabetic patients?]. Rev Med Suisse 2015; 11:493-498. [PMID: 25898457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Acute oxalate nephropathy is a severe cause of acute kidney injury characterized by tubule-interstitial oxalate deposits with an inflammatory infiltrate. Three cases of AKI occuring in diabetic patients, and whose renal biopsy gave a diagnosis of acute oxalate nephropathy are reported. This cristal deposit AKI is due to either primary hyperoxaluria or secondary to enteric hyperabsorption. Its prognosis is dismal and rapid recognition by renal biopsy and determination of the cause of hyperoxaluria is mandatory in order to avoid end-stage kidney disease. This diagnosis should be suspected in cases of non resolving AKI, especially in diabetic patients who may have undetected pancreatic exocrine insufficiency.
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Richman K, O'Bell J, Pareek G. The growing prevalence of kidney stones and opportunities for prevention. R I Med J (2013) 2014; 97:31-34. [PMID: 25463625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The prevalence of kidney stones is climbing in the United States. Several investigators have demonstrated an association between metabolic syndrome and kidney stones and some have proposed a causal link. Risk factors for nephrolithiasis can be identified with a 24-hour urine collection and preventive measures can be customized to meet the needs of individual patients. Dietary and pharmacologic interventions are available to address urinary risk factors such as inadequate urine volume, hypercalcuria, hyperoxaluria, hyperuricosuria and hypocitraturia. Given that morbidity and healthcare costs associated with nephrolithiasis are on the rise, deterring stone formation is increasingly important. Multidisciplinary clinics that foster collaboration between urologists, nephrologists and dieticians offer patients effective prevention and treatment strategies.
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Affiliation(s)
- Katherine Richman
- Physician in University Medicine's Division of Hypertension and Kidney Diseases and Assistant Professor of Medicine, The Warren Alpert Medical School of Brown University
| | - John O'Bell
- Assistant Director of the Kidney Stone Center at The Miriam Hospital and an Assistant Professor of Medicine at The Warren Alpert Medical School of Brown University, where he also serves as Program Director for the Renal Fellowship Program
| | - Gyan Pareek
- Director of the Kidney Stone Center at The Miriam Hospital and Director of minimally invasive urologic surgery at The Warren Alpert Medical School of Brown University, where he also is an Associate Professor of Surgery (urology)
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La Manna A, Apicella A, Cangiano G, Polito C. [Urolithiasis in children: diagnostic difficulties]. G Ital Nefrol 2013; 30:gin/00072.3. [PMID: 23832455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The incidence of urolithiasis in children has been steadily increasing in developed countries mainly due to changes in dietary habits. The occurrence of symptoms suggestive of urolithiasis in children with urinary solute abnormalities predisposing to stone formation but with normal renal ultrasound and X-ray plain film is approximately 9 times higher than the occurrence of overt stone disease. This discrepancy may depend on several factors, for example: the limited sensitivity of these methods of imaging, the presence of urinary crystals that, while not detectable with imaging, injure bladder epithelium, in addition to imaging studies performed after the passage of calculi giving negative results. Correct technique during urine collection is also essential for diagnosis. Urolithiasis must be suspected in the face of abdominal pain even central or diffuse pain in younger children when there is a positive family history even though specific urinary symptoms such hematuria and dysuria may be lacking.
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Shaĭlieva LO, Fedoseev GB, Zorina ML, Petrova MA, Trofimov VI, Kakliugin AP. [The treatment of patients with broncho-pulmonary pathology and concomitant disturbances of oxalic acid metabolism]. Klin Med (Mosk) 2013; 91:49-53. [PMID: 24437186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This work was aimed at estimating the role of special therapy of patients with bronchial asthma, COPD and hyperoxaluria designed to restrict the delivery or eliminate excess of oxalates and producing well apparent beneficial effect confirmed by the disappearance or decrease of clinical and functional manifestations of obstruction, reduction of requirements for broncholytic and anti-inflammatory agents.
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Abstract
CONTEXT Drawbacks of presently available treatments for urolithiasis necessitate finding the treatment of hyperoxaluria specifically aimed at reduction in oxalate excretion. Interestingly, many Indian tribes use Bombax ceiba L. (Bombacaceae) fruits as a traditional medicine for the treatment of urinary stones. OBJECTIVE The present study investigated the efficacy of B. ceiba fruit extracts as curative agents in experimentally induced calcium oxalate urolithiatic rats. MATERIALS AND METHODS Calcium oxalate lithiasis was induced in rats by oral administration of 0.75% ethylene glycol for 14 consecutive days. Treatments with aqueous and ethanol extract of B. ceiba fruit (400 mg/kg body weight) was performed in the same manner for further 14 consecutive days. Cystone (750 mg/kg body weight) was used as reference antiurolithiatic drug. The urinary excretion and kidney deposition of offending salt components, and serum biochemical parameters were investigated. RESULTS Oral administration of ethylene glycol resulted in hyperoxaluria and increased renal excretion of calcium and phosphate. However, supplementation with aqueous and ethanol extracts of B. ceiba fruit significantly (p < 0.05) reduced the elevated urinary oxalate, showing a regulatory action on endogenous oxalate synthesis. The increased deposition of stone forming constituents in kidneys of calculogenic rats was also significantly lowered with curative treatment of aqueous and ethanol extract. DISCUSSION AND CONCLUSION The results indicate that the fruit of B. ceiba is endowed with lithontriptic activity warranting further development for curative treatment of urolithiasis.
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Affiliation(s)
- N B Gadge
- Department of Pharmacognosy and Phytochemistry, KLE University's College of Pharmacy, JNMC Campus, Belgaum, Karnataka, India
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McPhail EF, Gettman MT, Patterson DE, Rangel LJ, Krambeck AE. Nephrolithiasis in medullary sponge kidney: evaluation of clinical and metabolic features. Urology 2011; 79:277-81. [PMID: 22014971 DOI: 10.1016/j.urology.2011.07.1414] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 06/20/2011] [Accepted: 07/22/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Medullary sponge kidney (MSK) is a disorder characterized by tubular dilation of renal collecting ducts and cystic dilation of medullary pyramids that has been associated with stone disease. The significance of nephrolithiasis and the mechanisms by which it occurs are incompletely understood. We describe clinical and metabolic features of nephrolithiasis in a cohort of patients with MSK. METHODS Records were reviewed of 56 patients, all with radiographic diagnosis of medullary sponge kidney and data collected pertaining to presentation, stone events and recurrences, stone composition, and metabolic profile to perform a descriptive study with median 3.7 years follow-up. RESULTS Nephrolithiasis was confirmed radiographically in 39/56 patients (69.6%). No patient without evidence of nephrolithiasis developed a stone event, whereas 13/39 (33%) of those with nephrolithiasis developed a recurrent stone event. Stones were composed of calcium oxalate monohydrate, calcium oxalate dihydrate, calcium phosphate apatite, and uric acid. Metabolic profile was obtained for 26 of 39 (67%) stone-forming patients demonstrating abnormalities in 22/26 (84.6%). These included hypercalciuria, 58% (15/26); low urine volume, 35% (9/26); hyperuricosuria, 27% (7/26); hypocitraturia, 19% (5/26); elevated urine sodium, 15% (4/26); and hyperoxaluria, 12% (3/26). CONCLUSION Many patients with MSK have no evidence of nephrolithiasis. Among those who do, recurrence is common, and metabolic profile and composition are varied as in the general stone-forming population.
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Affiliation(s)
- E Fred McPhail
- Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA
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Abstract
A 53-year-old contact lens wearer on renal dialysis developed visual impairment due to corneal opacity. The opacity was of a crystalline type and diffusely scattered in the anterior cornea. As oxalosis was suspected ascorbic acid was immediately omitted from the dialysis treatment schedule. Within a few weeks the visual acuity recovered and the corneas became nearly clear. The cornea is an uncommon manifestation site for oxalosis. Nevertheless, one should be aware of this possible sign for oxalosis, which can be a life-threatening complication of treatment with high dose ascorbic acid.
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Affiliation(s)
- S Peter
- Abteilung für Augenheilkunde, Landeskrankenhaus Feldkirch, Carinagasse 47, 6800, Feldkirch, Österreich.
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