Skip to main content
SpringerLink
Log in

Enteric hyperoxaluria, recurrent urolithiasis, and systemic oxalosis in patients with Crohn’s disease

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

Prevalence of recurrent calcium-oxalate (CaOx) urolithiasis (UL) is up to fivefold higher in Crohn’s disease than in the general population. Treatment options are scarce and the risk of recurrent UL or progressive renal CaOx deposition, (oxalosis) based early end-stage renal failure (ESRF), subsequent systemic oxalosis, and recurrence in the kidney graft is pronounced. We aimed to find proof that secondary hyperoxaluria is the main risk factor for the devastating course and correlates with intestinal oxalate absorption.

Methods

24-h urines were collected and analyzed for urinary oxalate (Uox) in 27 pediatric (6–18 years) and 19 adult patients (20–62 years). In the 21 patients (8 adults and 13 children) with hyperoxaluria a [13C2]oxalate absorption test was performed under standardized dietary conditions.

Results

Mean Uox was significantly higher in patients with UL or oxalosis (0.92 ± 0.57) compared with those without (0.53 ± 0.13 mmol/1.73 m2/24 h, p<0.05, normal < 0.5). Hyperoxaluria then significantly correlated with intestinal oxalate absorption (p< 0.05).

Conclusion

As UL/oxalosis has major implications for the general health in patients with Crohn’s disease (ESRF and systemic oxalosis), new medication, e.g. to reduce intestinal oxalate absorption, is definitely needed.

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

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. VanDervoort K, Wiesen J, Frank R, Vento S, Crosby V, Chandra M, Trachtman H (2007) Urolithiasis in pediatric patients: a single center study of incidence, clinical presentation and outcome. J Urol 177:2300–2305

    Article  PubMed  Google Scholar 

  2. Sas DJ, Hulsey TC, Shatat IF, Orak JK (2010) Increasing incidence of kidney stones in children evaluated in the emergency department. J Pediatr 157:132–137

    Article  PubMed  Google Scholar 

  3. Andersson H, Bosaeus I, Fasth S, Hellberg R, Hulten L (1987) Cholelithiasis and urolithiasis in Crohn's disease. Scand J Gastroenterol 22:253–256

    Article  PubMed  CAS  Google Scholar 

  4. Hoppe B, Leumann E, von Unruh G, Laube N, Hesse A (2003) Diagnostic and therapeutic approaches in patients with secondary hyperoxaluria. Front Biosci 8:e437–e443

    Article  PubMed  CAS  Google Scholar 

  5. Neuhaus TJ, Belzer T, Blau N, Hoppe B, Sidhu H, Leumann E (2000) Urinary oxalate excretion in urolithiasis and nephrocalcinosis. Arch Dis Child 82:322–326

    Article  PubMed  CAS  Google Scholar 

  6. 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 

  7. Williams HE, Wandzilak TR (1989) Oxalate synthesis, transport and the hyperoxaluric syndromes. J Urol 141:742–749

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  9. Binder HJ (1974) Intestinal oxalate absorption. Gastroenterology 67:441–446

    PubMed  CAS  Google Scholar 

  10. Dobbins JW, Binder HJ (1976) Effect of bile salts and fatty acids on the colonic absorption of oxalate. Gastroenterology 70:1096–1100

    PubMed  CAS  Google Scholar 

  11. Chadwick VS, Modha K, Dowling RH (1973) Mechanism for hyperoxaluria in patients with ileal dysfunction. N Engl J Med 289:172–176

    Article  PubMed  CAS  Google Scholar 

  12. Booth CC, Babouris N, Hanna S, Macintyre I (1963) Incidence of hypomagnesaemia in intestinal malabsorption. Br Med J 2:141–144

    Article  PubMed  CAS  Google Scholar 

  13. Trinchieri A, Lizzano R, Castelnuovo C, Zanetti G, Pisani E (2002) Urinary patterns of patients with renal stones associated with chronic inflammatory bowel disease. Arch Ital Urol Androl 74:61–64

    PubMed  Google Scholar 

  14. Rudman D, Dedonis JL, Fountain MT, Chandler JB, Gerron GG, Fleming GA, Kutner MH (1980) Hypocitraturia in patients with gastrointestinal malabsorption. N Engl J Med 303:657–661

    Article  PubMed  CAS  Google Scholar 

  15. Dobbins JW (1985) Nephrolithiasis and intestinal disease. J Clin Gastroenterol 7:21–24

    Article  PubMed  CAS  Google Scholar 

  16. Caudarella R, Rizzoli E, Pironi L, Malavolta N, Martelli G, Poggioli G, Gozzetti G, Miglioli M (1993) Renal stone formation in patients with inflammatory bowel disease. Scanning Microsc 7:371–379, discussion 379-380

    PubMed  CAS  Google Scholar 

  17. Hylander E, Jarnum S, Frandsen I (1979) Urolithiasis and hyperoxaluria in chronic inflammatory bowel disease. Scand J Gastroenterol 14:475–479

    PubMed  CAS  Google Scholar 

  18. Kyle J (1980) Urinary complications of Crohn's disease. World J Surg 4:153–160

    Article  PubMed  CAS  Google Scholar 

  19. Beck B, Habbig S, Feldkötter M, Wolf M, Bangen U, Michalk D, Stapenhorst L, Burst V, Stippel D, Fries J, Hoppe B (2008) How to handle the dilemma of ESRF and systemic oxalosis in short bowel syndrome from Crohn's disease - a potential application for Oxalobacter formigenes. Pediatr Nephrol 23:P065

    Google Scholar 

  20. Dick PT, Shuckett BM, Tang B, Daneman A, Kooh SW (1999) Observer reliability in grading nephrocalcinosis on ultrasound examinations in children. Pediatr Radiol 29:68–72

    Article  PubMed  CAS  Google Scholar 

  21. Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–263

    PubMed  CAS  Google Scholar 

  22. Sikora P, von Unruh GE, Beck B, Feldkotter 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 

  23. von Unruh GE, Langer MA, Paar DW, Hesse A (1998) Mass spectrometric-selected ion monitoring assay for an oxalate absorption test applying [13C2]oxalate. J Chromatogr B: Biomed Sci Appl 716:343–349

    Article  Google Scholar 

  24. Hoppe B, Jahnen A, Bach D, Hesse A (1997) Urinary calcium oxalate saturation in healthy infants and children. J Urol 158:557–559

    Article  PubMed  CAS  Google Scholar 

  25. Hylander E, Jarnum S, Jensen HJ, Thale M (1978) Enteric hyperoxaluria: dependence on small intestinal resection, colectomy, and steatorrhoea in chronic inflammatory bowel disease. Scand J Gastroenterol 13:577–588

    Article  PubMed  CAS  Google Scholar 

  26. Hesse A, Schneeberger W, Engfeld S, Von Unruh GE, 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]:S329–S333

    PubMed  CAS  Google Scholar 

  27. Asplin JR (2002) Hyperoxaluric calcium nephrolithiasis. Endocrinol Metab Clin North Am 31:927–949

    Article  PubMed  CAS  Google Scholar 

  28. Sikora P, Zajaczkowska M, Hoppe B (2009) Assessment of crystallization risk formulas in pediatric calcium stone-formers. Pediatr Nephrol 24:1997–2003

    Article  PubMed  Google Scholar 

  29. Laube N, Hoppe B, Hesse A (2005) Problems in the investigation of urine from patients suffering from primary hyperoxaluria type 1. Urol Res 33:394–397

    Article  PubMed  CAS  Google Scholar 

  30. 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 

  31. el-Habet AE, el-Sewedy SM, el-Sharaky A, Gaafar NK, Abdel-Rafee A, Hamoud F (1987) Biochemical studies on bilharzial and nonbilharzial hyperoxaluria: effect of pyridoxine and allopurinol treatment. Biochem Med Metab Biol 38:1–8

    Article  PubMed  CAS  Google Scholar 

  32. Zimmermann DJ, Hesse A, von Unruh GE (2005) Influence of a high-oxalate diet on intestinal oxalate absorption. World J Urol 23:324–329

    Article  PubMed  CAS  Google Scholar 

  33. Sidhu H, Schmidt ME, Cornelius JG, Thamilselvan 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 [Suppl 14]:S334–S340

    PubMed  CAS  Google Scholar 

  34. Kumar R, Mukherjee M, Bhandari M, Kumar A, Sidhu H, Mittal RD (2002) Role of Oxalobacter formigenes in calcium oxalate stone disease: a study from North India. Eur Urol 41:318–322

    Article  PubMed  CAS  Google Scholar 

  35. Duncan SH, Richardson AJ, Kaul P, Holmes RP, Allison MJ, Stewart CS (2002) Oxalobacter formigenes and its potential role in human health. Appl Environ Microbiol 68:3841–3847

    Article  PubMed  CAS  Google Scholar 

  36. Hoppe B, Beck B, Gatter N, von Unruh G, Tischer A, Hesse A, Laube N, Kaul P, Sidhu H (2006) Oxalobacter formigenes: a potential tool for the treatment of primary hyperoxaluria type 1. Kidney Int 70:1305–1311

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pediatric Nephrology, Department of Pediatric and Adolescent Medicine, University Hospital Cologne, Kerpenerstrasse 62, 50924, Cologne, Germany

    Renate Hueppelshaeuser, Sandra Habbig & Bernd Hoppe

  2. Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany

    Gerd E. von Unruh

  3. Institute of Human Genetics, University Hospital Cologne, Kerpenerstrasse 62, 50924, Cologne, Germany

    Bodo B. Beck

  4. Division of Experimental Urology, Department of Urology, University Hospital Bonn, Bonn, Germany

    Albrecht Hesse

  5. Department of Pediatrics, Marien-Hospital Bonn, Bonn, Germany

    Stephan Buderus

Authors
  1. Renate Hueppelshaeuser
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gerd E. von Unruh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sandra Habbig
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bodo B. Beck
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stephan Buderus
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Albrecht Hesse
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bernd Hoppe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bernd Hoppe.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOC 3944 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hueppelshaeuser, R., von Unruh, G.E., Habbig, S. et al. Enteric hyperoxaluria, recurrent urolithiasis, and systemic oxalosis in patients with Crohn’s disease. Pediatr Nephrol 27, 1103–1109 (2012). https://doi.org/10.1007/s00467-012-2126-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-012-2126-8

Keywords

Search

Navigation