Urological Research

, Volume 32, Issue 5, pp 311–316 | Cite as

The impact of dietary oxalate on kidney stone formation

  • Ross P. Holmes
  • Dean G. Assimos
Original Paper


The role of dietary oxalate in calcium oxalate kidney stone formation remains unclear. However, due to the risk for stone disease that is associated with a low calcium intake, dietary oxalate is believed to be an important contributing factor. In this review, we have examined the available evidence related to the ingestion of dietary oxalate, its intestinal absorption, and its handling by the kidney. The only difference identified to date between normal individuals and those who form stones is in the intestinal absorption of oxalate. Differences in dietary oxalate intake and in renal oxalate excretion are two other parameters that are likely to receive close scrutiny in the near future, because the research tools required for these investigations are now available. Such research, together with more extensive examinations of intestinal oxalate absorption, should help clarify the role of dietary oxalate in stone formation.


Oxalate Dietary oxalate Oxalate absorption Oxalate excretion Urolithiasis 


  1. 1.
    Zarembski PM, Hodgkinson A (1969) Some factors influencing the urinary excretion of oxalic acid in man. Clinica Chimica Acta 25: 1CrossRefGoogle Scholar
  2. 2.
    Holmes RP, Goodman HO, Assimos DG (2001) Contribution of dietary oxalate to urinary oxalate excretion. Kidney Int 59: 270CrossRefPubMedGoogle Scholar
  3. 3.
    Holmes RP, Kennedy M (2000) Estimation of the oxalate content of foods and daily oxalate intake. Kidney Int 57: 1662CrossRefPubMedGoogle Scholar
  4. 4.
    Siener R, Ebert D, Nicolav C, Hesse A (2003) Dietary risk factors for hyperoxaluria in calcium oxalate stone formers. Kidney Int 63: 1037CrossRefPubMedGoogle Scholar
  5. 5.
    Honow 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: 511CrossRefGoogle Scholar
  6. 6.
    Curhan GC, Willett WC, Rimm EB, Stampfer MJ (1993) A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. N Engl J Med 328: 833Google Scholar
  7. 7.
    Holmes RP, Goodman HO, Assimos DG (1995) Dietary oxalate and its intestinal absorption. Scanning Microsc 9: 1109PubMedGoogle Scholar
  8. 8.
    Hesse A, Schneeberger W, Engfeld S, Unruh GEV, Sauerbruch T (1999) Intestinal hyperabsorption of oxalate in calcium oxalate stone formers: application of a new test with [13C2]oxalate. J Am Soc Nephrol 10 [Suppl 14]: S329Google Scholar
  9. 9.
    Hatch M, Freel RW, Vaziri ND (1999) Regulatory aspects of oxalate secretion in enteric oxalate elimination. J Am Soc Nephrol 10 [Suppl 14]: S324Google Scholar
  10. 10.
    Krishnamurthy M, Hruska KA, Chandhoke PS (2003) The urinary response to an oral oxalate load in recurrent calcium stone formers. J Urol 169: 2030PubMedGoogle Scholar
  11. 11.
    Prenen JAC, Boer P, Mees EJD (1984) Absorption kinetics of oxalate from oxalate-rich food in man. Am J Clin Nutr 40: 1007PubMedGoogle Scholar
  12. 12.
    Hess B, Jost C, Zipperle L, Takkinen R, Jaeger P (1998) High-calcium intake abolishes hyperoxaluria and reduces urinary crystallization during a 20-fold normal oxalate load in humans. Nephrol Dial Transplant 13: 2241CrossRefPubMedGoogle Scholar
  13. 13.
    Liebman M, Chai W (1997) Effect of dietary calcium on urinary oxalate excretion after oxalate loads. Am J Clin Nutr 65: 1453PubMedGoogle Scholar
  14. 14.
    Sidhu H, Schmidt ME, CorneliusT JG, Thamiselvam S, Khan SR, Hesse A, Peck AB (1999) Direct correlation between hyperoxaluria/oxalate stone disease and the absence of the gastrointestinal tract dwelling bacterium Oxalobacter formigenes: possible prevention by gut recolonization or enzyme replacement therapy. J Am Soc Nephrol 10: S334PubMedGoogle Scholar
  15. 15.
    Mikami K, Akakura K, Takei K, Ueda T, Mizoguchi K, Noda M, Miyake M, Ito H (2003) Association of absence of intestinal oxalate degrading bacteria with urinary calcium oxalate stone formation. Int J Urol 10: 293CrossRefPubMedGoogle Scholar
  16. 16.
    Troxel SA, Sidhu H, Kaul P, Low RK (2003) Intestinal Oxalobacter formigenes colonization in calcium oxalate stone formers and its relation to urinary oxalate. J Endourol 17: 173CrossRefPubMedGoogle Scholar
  17. 17.
    Unruh GE von, Voss S, Sauerbruch T, Hesse A (2003) Reference range for gastrointestinal oxalate absorption measured with a standardized [13C2] oxalate absorption test. J Urol 169: 687PubMedGoogle Scholar
  18. 18.
    Holmes RP, Assimos DG, Goodman HO (1998) Genetic and dietary influences on urinary oxalate excretion. Urol Res 26: 195CrossRefPubMedGoogle Scholar
  19. 19.
    Mount DB, Romero MF (2004) The SLC26 gene family of multifunctional anion exchangers. Pflugers Arch-Eur J Physiol 447: 710Google Scholar
  20. 20.
    Hodgkinson A, Wilkinson R (1974) Plasma oxalate concentration and renal excretion of oxalate in man. Clin Sci Mol Med 46: 61PubMedGoogle Scholar
  21. 21.
    Prenen JAC, Boer P, Mees EJD, Endeman HJ, Spoor SM, Oei HY (1982) Renal clearance of [14C]oxalate:comparison of constant-infusion with single-injection techniques. Clin Sci 63: 47PubMedGoogle Scholar
  22. 22.
    Greger R, Lang F, Oberleithner H, Deetjen P (1978) Handling of oxalate by the rat kidney. Pflugers Arch 374: 243PubMedGoogle Scholar
  23. 23.
    Schwille PO, Manoharan M, Rumenapf G, Wolfel G, Berens H (1989) Oxalate measurement in the picomol range by ion chromatography: values in fasting plasma and urine of controls and patients with idiopathic calcium urolithiasis. J Clin Chem Clin Biochem 27: 87PubMedGoogle Scholar
  24. 24.
    Cattell WR, Spencer AG, Taylor GW, Watts RWE (1962) The mechanism of the renal excretion of oxalate in the dog. Clin Sci 22: 43PubMedGoogle Scholar
  25. 25.
    Williams HE, Johnson GA, Smith LH (1971) The renal clearance of oxalate in normal subjects and patients with primary hyperoxaluria. Clin Sci 41: 213PubMedGoogle Scholar
  26. 26.
    Weinman EJ, Frankfurt SJ, Ince A, Sansom S (1978) Renal tubular transport of organic acids. Studies with oxalate and para-aminohippurate in the rat. J Clin Invest 61: 801PubMedGoogle Scholar
  27. 27.
    Tremaine LM, Bird JE, Quebbemann AJ (1985) Renal tubular excretory transport of oxalate. J Pharmacol Exp Therap 233: 7Google Scholar
  28. 28.
    Knight TF, Sansom SC, Senekjian HO, Weinman EJ (1981) Oxalate secretion in the rat proximal tubule. AmeJ Physiol 240: F295Google Scholar
  29. 29.
    Markovich D, Bissig M, Sorribas V, Hagenbuch B, Meier PJ, Murer H (1994) Expression of rat renal sulfate transport systems in Xenopus laevis oocytes. J Biol Chem 269: 3022PubMedGoogle Scholar
  30. 30.
    Karniski LP, Lotscher M, Fucentese M, Hilfiker H, Biber J, Murer H (1998) Immunolocalization of sat-1 sulfate/oxalate/bicarbonate anion exchanger in the rat kidney. Am J Physiol 275: F79Google Scholar
  31. 31.
    Jiang Z, Grichtchenko II, Boron WF, Aronson PS (2002) Specificity of anion exchange mediated by mouse slc26a6. J Biol Chem 277: 33963CrossRefPubMedGoogle Scholar
  32. 32.
    Xie Q, Welch R, Mercado A, Romero MF, Mount DM (2002) Molecular characterization of the murine Slc26a6 anion exchanger: functional comparison with Slc26a1. Am J Physiol 283: F826Google Scholar
  33. 33.
    Lohi H, Kujala M, Makela S, Lehtonen E, Kestila M, Saarialho-Kere U, Markovich D, Kere J (2002) Functional characterization of three novel tissue-specific anion exchangers SLC26A7, -A8, and -A9. J Biol Chem 277: 14246CrossRefPubMedGoogle Scholar
  34. 34.
    Knauf F, Yang C-L, Thomson RB, Mentone AA, Giebisch G, Aronson PS (2001) Identification of a chloride-formate exchanger expressed on the brush border membrane of renal proximal tubule cells. Proc Natl Acad Sci U S A 98: 9425CrossRefPubMedGoogle Scholar
  35. 35.
    Lohi H, Lamprecht G, Markovich D, Heil A, Kujala M, Seidler U, Kere J (2003) Isoforms of SLC26A6 mediate anion transport and have functional PDZ interaction domains. Am J Physiol 284: C769Google Scholar
  36. 36.
    Selvam R (2002) Calcium oxalate stone disease: role of lipid peroxidation and antioxidants. Urol Res 30: 35PubMedGoogle Scholar
  37. 37.
    Jonassen JA, Cao LC, Honeyman T, Scheid CR (2003) Mechanisms mediating oxalate-induced alterations in renal cell functions. Crit Rev Eukaryot Gene Expr 13: 55PubMedGoogle Scholar
  38. 38.
    Fan J, Chandhkoe PS (1999) Examination of crystalluria in freshly voided urines of recurrent calcium stone formers and normal individuals using a new filter technique. J Urol 161: 1685PubMedGoogle Scholar
  39. 39.
    Koul S, Chaturvedi LS, Sekhon A, Bhandari A, Menon M, Koul HK (2002) Effects of oxalate on the re-initiation of DNA synthesis in LLC-PK1 cells do not involve p42/44 MAP kinase activation. Kidney Int 61: 525CrossRefPubMedGoogle Scholar
  40. 40.
    Borghi L, Schianchi T, Meschi T, Guerra A, Allegri F, Maggiore U, Novarini A (2002) Comparison of two diets for the prevention of recurrent stones in idiopathic hypercalciuria. N Engl J Med 346: 77Google Scholar
  41. 41.
    Albihn PBE, Savage GP (2001) The bioavailability of oxalate from oca (Oxalis tuberosa). J Urol 166: 420CrossRefPubMedGoogle Scholar
  42. 42.
    Massey LK, Grentz LM, Horner HT, Palmer RG (2002) Soybean and soyfood consumption increase oxalate excretion. Top Clin Nutr 17: 49Google Scholar
  43. 43.
    Brinkley L, McGuire J, Gregory J, Pak CY (1981) Bioavailability of oxalate in foods. Urology 17: 534PubMedGoogle Scholar
  44. 44.
    Brogren M, Savage GP (2003) Bioavailability of soluble oxalate from spinach eaten with and without milk products. Asia Pacific J Clin Nutr 12: 219Google Scholar
  45. 45.
    Savage GP, Charrier MJS, Vanhanen L (2003) Bioavailability of soluble oxalate from tea and the effect of consuming milk with the tea. Eur J Clin Nutr 57: 415CrossRefPubMedGoogle Scholar
  46. 46.
    Barilla DE, Notz C, Kennedy D, Pak CYC (1978) Renal oxalate excretion following oral oxalate loads in patients with ileal disease and with renal and absorptive hypercalciurias. Effect of calcium and magnesium. Am J Med 64: 579CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Ross P. Holmes
    • 1
  • Dean G. Assimos
    • 1
  1. 1.Department of UrologyWake Forest University Medical School

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