Skip to main content
SpringerLink
Log in

Metabolic profile and impact of diet in patients with primary hyperoxaluria

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

The primary goal of this pilot study was to evaluate metabolic characteristics and to examine the impact of diet in patients with primary hyperoxaluria (PH) under controlled, standardized conditions.

Methods

Four patients with genetically confirmed PH collected 24 h urines on their habitual, self-selected diets and on day 1, 6, 7, 8, and 11 under controlled, standardized conditions. The [13C2]oxalate absorption, calcium, and ammonium chloride loading tests were performed.

Results

While none of the patients had abnormal findings from the calcium loading test, incomplete distal renal tubular acidosis (RTA) was diagnosed in each of the four patients. Dietary intervention resulted in a significant decrease in urinary oxalate expressed as molar creatinine ratio (mmol/mol) between 30 and 40% in two of four patients. The evaluation of dietary records revealed a high daily intake of oxalate-rich foods as well as gelatin-containing sweets and meat products, rich sources of hydroxyproline, under the habitual, self-selected diets of the two responders. Intestinal oxalate hyperabsorption of 12.4% in one of the two patients may have additionally contributed to the increased urinary oxalate excretion under the individual diet.

Conclusions

Our pilot data indicate that patients with PH may benefit from a restriction of dietary oxalate and hydroxyproline intake. Further research is needed to define the role of distal RTA in PH and to evaluate the hypothesis of an acquired acidification defect.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Hoppe B, Beck BB, Milliner DS (2009) The primary hyperoxalurias. Kidney Int 75:1264–1271

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Ermer T, Eckardt KU, Aronson PS, Knauf F (2016) Oxalate, inflammasome, and progression of kidney disease. Curr Opin Nephrol Hypertens 25:363–371

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. Hesse A, Tiselius HG, Siener R, Hoppe B (2009) Urinary stones. Diagnosis, treatment, and prevention of recurrence, 3rd revised and enlarged edn. Karger, Basel

    Book  Google Scholar 

  4. Leumann E, Hoppe B, Neuhaus T, Blau N (1995) Efficacy of oral citrate administration in primary hyperoxaluria. Nephrol Dial Transplant 10(Suppl 8):14–16

    Article  PubMed  Google Scholar 

  5. Hoppe B, Groothoff JW, Hulton SA, Cochat P, Niaudet P, Kemper MJ, Deschênes G, Unwin R, Milliner D (2011) Efficacy and safety of Oxalobacter formigenes to reduce urinary oxalate in primary hyperoxaluria. Nephrol Dial Transplant 26:3609–3615

    Article  PubMed  Google Scholar 

  6. Hoyer-Kuhn H, Kohbrok S, Volland R, Franklin J, Hero B, Beck BB, Hoppe B (2014) Vitamin B6 in primary hyperoxaluria I: first prospective trial after 40 years of practice. Clin J Am Soc Nephrol 9:468–477

    Article  PubMed  PubMed Central  Google Scholar 

  7. Sikora P, von Unruh GE, Beck B, Feldkötter M, Zajaczkowska M, Hesse A, Hoppe B (2008) [13C2]oxalate absorption in children with idiopathic calcium oxalate urolithiasis or primary hyperoxaluria. Kidney Int 73:1181–1186

    Article  PubMed  CAS  Google Scholar 

  8. Siener R, Jahnen A, Hesse A (2004) Influence of a mineral water rich in calcium, magnesium and bicarbonate on urine composition and the risk of calcium oxalate crystallization. Eur J Clin Nutr 58:270–276

    Article  PubMed  CAS  Google Scholar 

  9. von Unruh GE, Voss S, Sauerbruch T, Hesse A (2003) Reference range for gastrointestinal oxalate absorption measured with a standardized [13C2]oxalate absorption test. J Urol 169:687–690

    Article  Google Scholar 

  10. Schwartz GJ, Munoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20:629–637

    Article  PubMed  PubMed Central  Google Scholar 

  11. Levey AS, Coresh J, Greene T, Marsh J, Stevens LA, Kusek JW, van Lente F (2007) Expressing the modification of diet in renal disease study equation for estimating glomerular filtration rate with standardized serum creatinine values. Clin Chem 53:766–772

    Article  PubMed  CAS  Google Scholar 

  12. Gambaro G, Croppi E, Coe F, Lingeman J, Moe O, Worcester E, Buchholz N, Bushinsky D, Curhan GC, Ferraro PM, Fuster D, Goldfarb DS, Heilberg IP, Hess B, Lieske J, Marangella M, Milliner D, Preminger GM, Reis Santos JM, Sakhaee K, Sarica K, Siener R, Strazzullo P, Williams JC, The Consensus Conference Group (2016) Metabolic diagnosis and medical prevention of calcium nephrolithiasis and its systemic manifestations: a consensus statement. J Nephrol 29:715–734

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Pak CYC, Poindexter JR, Peterson RD, Heller HJ (2004) Biochemical and physicochemical presentations of patients with brushite stones. J Urol 171:1046–1049

    Article  PubMed  Google Scholar 

  14. Thamilselvan S, Khan SR (1998) Oxalate and calcium oxalate crystals are injurious to renal epithelial cells: results of in vivo and in vitro studies. J Nephrol 11:66–69

    PubMed  Google Scholar 

  15. Parks JH, Coe FL, Evan AP, Worcester EM (2009) Urine pH in renal calcium stone formers who do and do not increase stone phosphate content with time. Nephrol Dial Transplant 24:130–136

    Article  PubMed  CAS  Google Scholar 

  16. Backman U, Danielson BG, Johansson G, Ljunghall S, Wikström B (1980) Incidence and clinical importance of renal tubular defects in recurrent renal stone formers. Nephron 25:96–101

    Article  PubMed  CAS  Google Scholar 

  17. Leumann E, Hoppe B (2001) The primary hyperoxalurias. J Am Soc Nephrol 12:1986–1993

    PubMed  CAS  Google Scholar 

  18. Holmes RP, Goodman HO, Assimos DG (2001) Contribution of dietary oxalate to urinary oxalate excretion. Kidney Int 59:270–276

    Article  PubMed  CAS  Google Scholar 

  19. Hönow R, Hesse A (2002) Comparison of extraction methods for the determination of soluble and total oxalate in foods by HPLC-enzyme-reactor. Food Chem 78:511–521

    Article  Google Scholar 

  20. Siener R, Hönow R, Seidler A, Voss S, Hesse A (2006) Oxalate contents of species of the Polygonaceae, Amaranthaceae and Chenopodiaceae families. Food Chem 98:220–224

    Article  CAS  Google Scholar 

  21. Schroder T, Vanhanen L, Savage GP (2011) Oxalate content in commercially produced cocoa and dark chocolate. J Food Compos Anal 24:916–922

    Article  CAS  Google Scholar 

  22. Hönow R, Gu KLR, Hesse A, Siener R (2010) Oxalate content of green tea of different origin, quality, preparation and time of harvest. Urol Res 38:377–381

    Article  PubMed  CAS  Google Scholar 

  23. Siener R, Seidler A, Voss S, Hesse A (2016) The oxalate content of fruit and vegetable juices, nectars and drinks. J Food Compos Anal 45:108–112

    Article  CAS  Google Scholar 

  24. Siener R, Bade DJ, Hesse A, Hoppe B (2013) Dietary hyperoxaluria is not reduced by treatment with lactic acid bacteria. J Transl Med 11:306. https://doi.org/10.1186/1479-5876-11-306

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. Knight J, Holmes RP, Cramer SD, Takayama T, Salido E (2012) Hydroxyproline metabolism in mouse models of primary hyperoxaluria. Am J Physiol Renal Physiol 302:F688–F693

    Article  PubMed  CAS  Google Scholar 

  26. Knight J, Jiang J, Assimos DG, Holmes RP (2006) Hydroxyproline ingestion and urinary oxalate and glycolate excretion. Kidney Int 70:1929–1934

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  27. von Unruh GE, Voss S, Sauerbruch T, Hesse A (2004) Dependence of oxalate absorption on the daily calcium intake. J Am Soc Nephrol 15:1567–1573

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, University Stone Centre, University of Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany

    Roswitha Siener, Patricia Löhr, Stefan C. Müller & Stefan Latz

  2. Division of Pediatric Nephrology, Department of Pediatrics, University of Bonn, Bonn, Germany

    Bernd Hoppe

Authors
  1. Roswitha Siener
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bernd Hoppe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Patricia Löhr
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefan C. Müller
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stefan Latz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roswitha Siener.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Siener, R., Hoppe, B., Löhr, P. et al. Metabolic profile and impact of diet in patients with primary hyperoxaluria. Int Urol Nephrol 50, 1583–1589 (2018). https://doi.org/10.1007/s11255-018-1939-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-018-1939-1

Keywords

Search

Navigation