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The Use of Probiotic Bacteria to Treat Recurrent Calcium Oxalate Kidney Stone Disease

  • Chapter
The Role of Bacteria in Urology

Abstract

Calcium oxalate-based kidney stones are the most common type found amongst idiopathic stone-forming patients. Excess dietary oxalate can be excreted via the faeces as well as the urine, and consumption of oxalate degrading probiotic bacteria might assist in reducing hyperoxaluria by degrading dietary oxalate in the gastrointestinal tract (GIT) before it can be absorbed. This chapter describes the genetic and in vitro aspects of microbial oxalate metabolism, and reviews in vivo trials involving the use of specific probiotic bacteria. Recent novel approaches using ingested purified oxalate degrading enzymes or in vivo expression of recombinant enzymes to reduce hyperoxalauria are also discussed.

In vitro studies have shown that certain Lactobacillus and Bifidobacterium species may have great potential for use as oxalate degrading probiotics since they reduce oxalate but can also survive in the gut under conditions where oxalate is limited. Gut colonisation and in vivo bacterial oxalate utilization studies in humans have shown a similar trend towards reducing oxalate levels. However, most of these interventions have been limited in their scope and need more rigorous investigation to measure their therapeutic value. A recent alternative approach used known amounts of in vitro purified recombinant oxalate decarboxylase enzyme to treat hyperoxaluria in animal models. These showed urinary oxalate degradation and low toxicity. Rats colonised with Lactobacillus plantarum expressing this recombinant enzyme also showed a significant reduction in urinary oxalate. The approaches reviewed here show potential therapeutic value in vitro, but all require extensive further evaluation in well-designed human trials.

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Authors and Affiliations

  1. Molecular and Cell Biology, University of Cape Town, Rondebosch Cape Town, Western Province, 7701, South Africa

    Brian R. Kullin PhD, Sharon J. Reid PhD & Valerie R. Abratt PhD

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  1. Brian R. Kullin PhD
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  2. Sharon J. Reid PhD
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  3. Valerie R. Abratt PhD
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Correspondence to Valerie R. Abratt PhD .

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Editors and Affiliations

  1. Basic Science Research, The Stone Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada

    Dirk Lange

  2. Clinical Research, The Stone Center at Vancouver General Hospital, Vancouver, British Columbia, Canada

    Ben Chew

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Kullin, B.R., Reid, S.J., Abratt, V.R. (2016). The Use of Probiotic Bacteria to Treat Recurrent Calcium Oxalate Kidney Stone Disease. In: Lange, D., Chew, B. (eds) The Role of Bacteria in Urology. Springer, Cham. https://doi.org/10.1007/978-3-319-17732-8_7

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