Abstract
It has been known for 25 years that nephrolithiasis occurs more commonly in patients with intestinal disease than in the general population (Deren et al. 1962; Gelzayd et al. 1968). The majority of stones in these patients are composed predominantly of calcium oxalate (Gelzayd et al. 1968), and a mechanism to explain this observation became apparent with the demonstration about 15 years ago that individuals with ileal disease or resection excrete increased amounts of oxalate in the urine (Dowling et al. 1971; Admirand et al. 1971; Smith et al. 1972). The aim of this paper is to review present knowledge about the cause, clinical significance and treatment of enteric hyperoxaluria (EHO). In the course of a resumé of pertinent aspects of oxalate metabolism, other types of secondary hyperoxaluria will be briefly mentioned.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Admirand WH, Earnest DL, Williams HE (1971) Hyperoxaluria and bowel disease. Trans Assoc Am Physicians 84: 307–312
Allison MJ, Cook HM, Milne DB, Gallagher S, Clayman RV (1986) Oxalate degradation by gastrointestinal bacteria from humans. J Nutr 116: 455–460
Andersson H, Gillberg R (1977) Urinary oxalate on a high oxalate diet as a clinical test of malabsorption. Lancet II: 677–679
Andersson H, Jagenburg R (1974) Fat-reduced diet in the treatment of hyperoxaluria in patients with ileopathy. Gut 15: 360–366
Andersson H, Filipsson S, Hulten L (1978) Urinary oxalate excretion related to ileocolic surgery in patients with Crohn’s disease. Scand J Gastroenterol 13: 465–469
Anonymous (1987) Allopurinol for calcium oxalate stones? Lancet I: 258–259
Argenzio RA, Laicos JA, Allison MJ (1985) Role of intestinal oxalate degrading bacteria in the pathogenesis of enteric hyperoxaluria. Gastroenterology 88: 1309
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: 579–585
Binder HJ (1973) Faecal fatty acids — mediators of diarrhoea? Gastroenterology 65: 847–850
Binder HJ (1974) Intestinal oxalate absorption. Gastroenterology 67: 441–446
Booth CC, Babouris N, Hanna S, Maclntyre I (1963) Incidence of hypomagnesaemia in intesdnal malabsorption. Br Med J 2: 141–144
Briggs MH, Garcia-Webb P, Davies P (1973) Urinary oxalate and vitamin C supplements. Lancet II: 201
Brinkley L, Muire J, Gregory J, Pak CYC (1981) Bioavailability of oxalate in foods. Urology 17: 534–538
Caspary WF (1977) Intestinal oxalate absorption. 1. Absorption in vitro. Res Exp Med 171: 13–24
Caspary WF, Tönissen J, Lankisch PG (1977) ‘Enteral’ hyperoxaluria. Effect of cholestyramine, calcium, neomycin and bile acids on intestinal oxalate absorption in man. Acta Hepato-Gastroenterol 24: 193–200
Chadwick VS, Modha K, Dowling RH (1973) Mechanism for hyperoxaluria in patients with ileal dysfunction. New Engl J Med 289: 172–176
Chadwick VS, Elias E, Bell GD, Dowling RH (1975) The role of bile acids in the increased intestinal absorption of oxalate after ileal resection. In: Matern S, Hackenschmidt J, Back P, Gerok W (eds) Advances in Bile Acid Research. Schattauer, Stuttgart, pp 435–440
Coe FL (1978) Hyperuricosuria and calcium oxalate nephrolithiasis. Kidney Int 13: 418–426
Das S, Joseph B, Dilk AL (1979) Renal failure owing to oxalate nephrosis after jejuno-ileal bypass. J Urol 121: 506–509
Deren JJ, Porush JG, Levitt MF, Khilani MT (1962) Nephrolithiasis as a complication of ulcerative colitis and regional enteritis. Ann Intern Med 56: 843–853
Dharmsathaphorn K, Freeman D, Binder HJ, Dobbins JW (1982) Increased risk of nephrolithiasis in patients with steatorrhoea. Dig Dis Sci 27: 401–405
Dickstein SS, Frame B (1973) Urinary tract calculi after intestinal shunt operations for the treatment of obesity. Surg Gynaecol Obstet 136: 257–260
Dobbins JW, Binder HJ (1976) Effect of bile salts and fatty acids on the colonic absorption of oxalate. Gastroenterology 70: 1096–1100
Dobbins JW, Binder HJ (1977) Importance of the colon in enteric hyperoxaluria. New Engl J Med 296: 298–301
Dowling RH, Rose GA, Sutor DJ (1971) Hyperoxaluria and renal calcuh in ileal disease. Lancet I: 1103–1106
Drenick EJ, Stanley TM, Border WA et al. (1978) Renal damage with intestinal bypass. Ann Intern Med 89: 594–599
Dvorackova I (1966) Tödliche Vergiftungnach intravenöser Verabreichung von Natriumoxalat. Arch Toxikol 22: 63–67
Earnest DL, Johnson G, Williams HE, Admirand WH (1974) Hyperoxaluria in patients with ileal resection: an abnormality in dietary oxalate absorption. Gastroenterology 66: 1114–1122
Earnest DL, Wilhams HE, Admirand WH (1975a) Treatment of enteric hyperoxaluria with calcium and medium chain triglyceride. Chn Res 23: 130
Earnest DL, Williams HE, Admirand WH (1975b) A physicochemical basis for treatment of enteric hyperoxaluria. Trans Assoc Am Physicians 88: 224–234
Earnest DL, Williams HE, Admirand WH (1975c) An explanation for the presence or absence of hyperoxaluria in patients with jejuno-ileal bypass. Gastroenterology 68: 1072
Earnest DL (1977) Perspectives on incidence, aetiology and treatment of enteric hyperoxaluria. Am J Clin Nutr 30: 72–75
Earnest DL, Campbell J, Hunt TK et al. (1977) Progressive renal failure with hyperoxaluria: a new complication of jejuno-ileal bypass. Gastroenterology 72: 1054
Earnest DL (1979) Enteric hyperoxaluria. Adv Intern Med 24: 407–427
Ettinger B, Tang A, Citron JT, Livermore B, Williams T (1986) Randomized trial of allopurinol in the prevention of calcium oxalate calculi. New Engl J Med 315: 1386–1389
Fairclough PD, Feest TG, Chadwick VS, Clark ML (1977) Effect of sodium chenodeoxycholate on oxalate absorption from the excluded human colon — a mechanism for ‘enteric’ hyperoxaluria. Gut 18: 240–244
Finch AM, Kasidas GP, Rose GA (1981) Urine composition in normal subjects after oral ingestion of oxalate-rich foods. Clin Sci 60: 411–418
Fitzpatrick JM, Kasidas GP, Rose GA (1981) Hyperoxaluria following glycine irrigation for transurethral prostatectomy. Br J Urol 53: 250–252
Foster PN, Will EJ, Kelleher J, Losowsky MS (1984) Oxalate loading tests to screen for steatorrhoea: an appraisal. Clin Chim Acta 144: 155–161
Frascino JA, Vanamee P, Rosen PP (1970) Renal oxalosis and azotemia after methoxyfiuorane anaesthesia. New Engl J Med 283: 676–679
Freel RW, Hatch M, Earnest DL, Goldner A (1980) Oxalate transport across the isolated rat colon. A re-examination. Biochim Biophys Acta 600: 838–843
Gelbart DR, Brewer LL, Weinstein AB (1977) Oxalosis and chronic renal failure after intestinal bypass. Arch Intern Med 137: 239–243
Gelzayd EA, Breuer RI, Kirsner JB (1968) Nephrolithiasis in inflammatory bowel disease. Amer J Dig Dis 13: 1027–1034
Goldkind R, Cave DR, Jaffin B, Bliss CM, Allison MJ (1986) Bacterial oxalate metabolism in the human colon: a possible factor in enteric hyperoxaluria. Gastroenterology 90: 1431
Gregory JG, Starkloff EB, Miyai K, Schoenberg HW (1975) Urologie comphcations of ileal bypass operation for morbid obesity. J Urol 113: 521–524
Gregory JG, Park KY, Schoenberg HW (1977) Oxalate stone disease after intestinal resection. J Urol 117: 631–634
Hatch M, Freel RW, Goldner AM, Earnest DL (1984) Oxalate and chloride absorption by the rabbit colon: sensitivity to metabolic and anion transport inhibitors. Gut 25: 232–237
Heaton KW, Lever JV, Barnard D (1972) Osteomalacia associated with cholestyramine therapy for post-ileectomy diarrhoea. Gastroenterology 62: 642–646
Hodgkinson A (1977) Oxalic acid in biology and medicine. Academic Press, New York
Hodgkinson A (1978) Evidence of increased oxalate absorption in patients with calcium-containing stones. Clin Sci 54: 291–294
Hofmann AF, Thomas PJ, Smith LH et al. (1970) Pathogenesis of secondary hyperoxaluria in patients with ileal resection and diarrhoea. Gastroenterology 58: 960
Hofmann AF, Poley JR (1972) Role of bile acid malabsorption in pathogenesis of diarrhoea and steatorrhoea in patients with ileal resection. L Response to cholestyramine or replacement of dietary long chain triglyceride by medium chain triglyceride. Gastroenterology 62: 918–934
Hofmann AF, Tacker M, Fromm H, Thomas PJ, Smith LH (1973) Acquired hyperoxaluria and intestinal disease. Evidence that bile acid glycine is not a precursor of oxalate. Mayo Clin Proc 48: 35–42
Hofmann AF, Schmuck G, Scopinaro N et al. (1981) Hyperoxaluria associated with intestinal bypass surgery for morbid obesity: occurrence, pathogenesis and approaches to treatment. Int J Obesity 5: 513–518
Hofmann AK, Laker MF, Dharmsathaphorn K, Sherr HP, Lorenzo D (1983) Complex pathogenesis of hyperoxaluria after jejunoileal bypass surgery. Oxalogenic substances in diet contribute to urinary oxalate. Gastroenterology 84: 293–300
Hylander E, Jarnum S, Juel Jensen H, Thale M (1978) Enteric hyperoxaluria; dependence on small intestinal resection, colectomy and steatorrhoea in chronic inflammatory bowel disease. Scand J Gastroenterol 13: 577–588
Hylander E, Jarnum S, Frandsen I (1979) Urolithiasis and hyperoxaluria in chronic inflammatory bowel disease. Scand J Gastroenterol 14: 475–479
Hylander E, Jarnum S, Neilsen K (1980) Calcium treatment of enteric hyperoxaluria after jejunoileal bypass for morbid obesity. Scand J Gastroenterol 15: 349–352
Jeghers H, Murphy R (1945) Practical aspects of oxalate metabolism. New Engl J Med 233: 204–215
Johns WH, Bates TR (1970) Quantification of the binding tendencies of cholestyramine. II: mechanism of interaction with bile salt and fatty acid salt anions. J Pharm Sci 59: 329–333
Kasidas GP, Rose G A (1980) Oxalate content of some common foods: determination by an enzymatic method. J Hum Nutr 34: 255–266
Kathpaha SC, Favus MJ, Coe FL (1984) Evidence for size and charge perm-selectivity of rat ascending colon: effects of ricinoleate and bile salts on oxalic acid and neutral sugar transport. J Chn Invest 74: 805–811
Knichelbein RG, Aronson PS, Dobbins JW (1986) Oxalate transport by anion exchange across rabbit ileal brush border. J Clin Invest 77: 170–175
Laker MF, Hofmann AF (1981) Effective therapy of enteric hyperoxaluria: in vitro binding of oxalate by anion exchange resins and aluminium hydroxide. J Pharm Sci 70: 1065–1067
Laker MF (1983) The clinical chemistry of oxalate metabolism. Adv Clin Chem 23: 259–297
Marangella M, Frutterò B, Bruno M, Linari F (1982) Hyperoxaluria in idiopathic stone disease: further evidence of intestinal hyperabsorption of oxalate. Clin Sci 63: 381–385
Mekhjian HS, Phillips SF (1970) Perfusion of the canine colon with unconjugated bile acids: the effect on water and electrolyte transport, morphology and bile acid absorption. Gastroenterology 59: 120–129
Mekhjian HS, Phillips SF, Hofmann AF (1971) Colonic secretion of water and electrolytes induced by bile acids: perfusion studies in man. J Clin Invest 50: 1569–1577
Meldrum SJ, Watson BW, Riddle HC, Brown RL, Sladen GE (1972) profile of gut as measured by radiotelemetry capsule. Br Med J 2: 104–106
Monald GB, Earnest DL, Admirand WH (1977) Hyperoxaluria correlates with fat malabsorption in patients with sprue. Gut 18: 561–566
Modigliani R, Labayle D, Aymes C, Denvil R (1978) Evidence for excessive absorption of oxalate by the colon in enteric hyperoxaluria. Scand J Gastroenterol 13: 187–192
Nordenvall B, Backman L, Larsson L, Tisus H-G (1983a) Effects of calcium, aluminium, magnesium and cholestyramine on hyperoxaluria in patients with jejunoileal bypass. Acta Chir Scand 149: 93–98
Nordenvall KJ, Hallberg D, Larsson L, Nord CE (1983b) The effect of clindamycin on the intestinal flora in patients with enteric hyperoxaluria. Scand J Gastroenterol 18: 177–181
O’Leary JP, Thomas WC, Woodward ER (1974) Urinary tract stone after small bowel bypass for morbid obesity. Am J Surg 127: 142–147
Parry MF, Wallach R (1974) Ethylene glycol poisoning. Am J Med 57: 143–150
Rampton DS, Kasidas GP, Rose GA, Sarner M (1979) Oxalate loading test: a screening test for steatorrhoea. Gut 20: 1089–1094
Rampton DS, Breuer NF, Vaja SG, Sladen GE, Dowling RH (1981) Role of prostaglandins in bile salt-induced changes in rat colonic structure and function. Clin Sci 61: 641–648
Rampton DS, Mullough DA, Sabbat JS, Salisbury JR, Flynn FV, Sarner M (1984) Screening for steatorrhoea with an oxalate loading test. Br Med J 288: 1419–1728
Ribaya JD, Gershoff SN (1982) Factors affecting endogenous oxalate synthesis and its excretion in feces and urine of rats. J Nutr 112: 2161–2169
Rofe AM, Conyers RAJ, Bais R, Edwards JB (1979) Oxalate excretion in rats injected with xtol or glycollate: stimulation by phenobarbitone pre-treatment. Aus J Exp Biol Med Sci 57: 171–176
Rudman D, Dedonis JL, Fountain MT et al. (1980) Hypocitraturia in patients with gastrointestinal malabsorption. New Engl J Med 303: 657–661
Saunders DR, Sillery J, Monald GB (1975) Regional differences in oxalate absorption by rat intestine: evidence for excessive absorption by the colon in steatorrhoea. Gut 16: 543–554
Schmidt KH, Hagmaier V, Hornig DH, Vuilleumier JP, Rutishauser G (1981) Urinary oxalate excretion after large intakes of ascorbic acid in man. Am J Clin Nutr 34: 305–311
Schwartz SE, Stauffer JQ, Burgess LW, Cheney M (1980) Oxalate uptake by everted sacs of rat colon. Biochim Biophys Acta 596: 404–413
Scott R, Paterson PJ, Mathieson A, Smith M (1978) The effect of allopurinol on urinary oxalate excretion. Br J Urol 50: 455–458
Simmonds NA, Van Acker KJ, Potter CF, Webster DR, Kasidas GP, Rose GA (1981) Influence of purine content of diet and allopurinol on uric acid and oxalate excretion levels. In: Smith LH, Robertson WG, Finlayson B (eds) Urohthiasis: clinical and basic research. Plenum, New York, pp 363–378
Smith LH, Hofmann AF, McCall JT, Thomas PJ (1970) Secondary hyperoxaluria in patients with ileal resection and oxalate nephrolithiasis. Clin Res 18: 541
Smith LH, Fromm H, Hofmann AF (1972) Acquired hyperoxaluria, nephrolithiasis and intestinal disease. New Engl J Med 286: 1371–1375
Smith LH (1980) Enteric hyperoxaluria and other hyperoxaluric states. In: Coe FL (guest ed), Brenner BM, Stein JH (eds) Contemporary Issues in Nephrology vol 5. Churchill Livingstone, New York, pp 215–238
Stauffer JQ, Humphreys MH, Weir JG (1973) Acquired hyperoxaluria with regional enteritis after ileal resection. Ann Intern Med 79: 383–391
Stauffer JQ (1977a) Hyperoxaluria and calcium oxalate nephrolithiasis after jejunoileal bypass. Am J Clin Nutr 30: 64–71
Stauffer JO (1977b) Hyperoxaluria and intestinal disease. The role of steatorrhoea and dietary calcium in regulating intestinal oxalate absorption. Dig Dis Sci 22: 921–928
Thomas DW, Edwards JB, Gilligan JE, Lawrence JR, Edwards RG (1972) Complications following intravenous administration of solutions containing xtol. Med J Aust 1: 1238–1246
Tomlinson B, Cohen SL, Al-Khader A, Kasidas GP, Rose GA (1985) Further reduction of oxalate by allopurinol in stone formers on low purine diet. In: Schwille PO, Smith LH, Robertson WG, Vahlensieck W (eds) Urolithiasis and related clinical research. Plenum, New York, pp 513–516
Tiselius HG, Ahlstrand C, Lundström B, Nilsson MA (1981) (14C) oxalate absorption by normal persons, calcium oxalate stone formers, and patients with surgically disturbed intestinal function. Clin Chem 27: 1682–1685
Vainder M, Kelly J (1982) Renal tubular function secondary to jejuno-ileal bypass. J Am Med Assoc 235: 1257–1258
West RJ, Lloyd JK (1975) The effect of cholestyramine on intestinal absorption. Gut 16: 93–98
Zarembski PM, Hodgkinson A (1969) Some factors influencing the urinary excretion of oxahc acid in man. Chn Chim Acta 25: 1–10
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1988 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Rampton, D.S., Sarner, M. (1988). Enteric and Other Secondary Hyperoxalurias. In: Rose, G.A. (eds) Oxalate Metabolism in Relation to Urinary Stone. The Bloomsbury Series in Clinical Science. Springer, London. https://doi.org/10.1007/978-1-4471-1626-4_7
Download citation
DOI: https://doi.org/10.1007/978-1-4471-1626-4_7
Publisher Name: Springer, London
Print ISBN: 978-1-4471-1628-8
Online ISBN: 978-1-4471-1626-4
eBook Packages: Springer Book Archive