Nephrolithiasis in Patients with Gastrointestinal Disorders
- 508 Downloads
Abstract
Patients with malabsorptive gastrointestinal disorders are at higher risk of kidney stones than those without. These disorders include inflammatory bowel diseases, with or without bowel resection, chronic pancreatitis, and celiac disease. The malabsorption of water, sodium, oxalate, bicarbonate, and fat leads to increased urinary concentration of stone-forming factors. The most common stones seen in gastrointestinal disorders contain calcium oxalate or uric acid. Major risk factors for stone formation are decreased urinary volume, hyperuricosuria, and hypocitraturia from high gastrointestinal output, and enteric hyperoxaluria from fat malabsorption. Prevention of kidney stones in such patients requires modifying standard stone-forming risk factors, but special consideration should be paid to metabolic abnormalities specific to this patient population. Treatment of the underlying gastrointestinal disorders also results in decreased incidence of kidney stones in this group.
Keywords
Malabsorption Inflammatory bowel disease Crohn’s disease Ulcerative colitis Ileostomy Celiac disease Bacterial overgrowth Chronic pancreatitis HyperoxaluriaReferences
- 1.Deren JJ, Porush JG, Levitt MF, et al. Nephrolithiasis as a complication of ulcerative colitis and regional enteritis. Ann Intern Med. 1962;56:843–53.PubMedCrossRefGoogle Scholar
- 2.Bambach CP, Robertson WG, Peacock M, et al. Effect of intestinal surgery on the risk of urinary stone formation. Gut. 1981;22:257–63.PubMedPubMedCentralCrossRefGoogle Scholar
- 3.Clarke AM, McKenzie RG. Ileostomy and the risk of urinary uric acid stones. Lancet. 1969;2:395–7.PubMedCrossRefGoogle Scholar
- 4.Kennedy HJ, Al-Dujaili EAS, Edwards CRW, et al. Water and electrolyte balance in subjects with a permanent ileostomy. Gut. 1983;24:702–5.PubMedPubMedCentralCrossRefGoogle Scholar
- 5.Hill GL, Goligher JC, Smith AH, et al. Long term changes in total body water, total exchangeable sodium and total body potassium before and after ileostomy. Br J Surg. 1975;62:524–7.PubMedCrossRefGoogle Scholar
- 6.Ingimarsson JP, Krambeck AE, Pais VM. Diagnosis and management of nephrolithiasis. Surg Clin North Am. 2016;96(3):517–32.PubMedCrossRefGoogle Scholar
- 7.Stelzner M, Phillips JD, Saleh S, et al. Nephrolithiasis and urine ion changes in ulcerative colitis patients undergoing colectomy and endorectal ileal pullthrough. J Surg Res. 1990;48:552–6.PubMedCrossRefGoogle Scholar
- 8.Caudarella R, Rizzoli E, Pironi L, et al. Renal stone formation in patients with inflammatory bowel disease. Scanning Microsc. 1993;7:371–80.PubMedGoogle Scholar
- 9.Galland L. Magnesium and inflammatory bowel disease. Magnesium. 1988;7:78–83.PubMedGoogle Scholar
- 10.Rudman D, Dedonis JL, Fountain MT, et al. Hypocitraturia in patients with gastrointestinal malabsorption. N Engl J Med. 1980;303:657–61.PubMedCrossRefGoogle Scholar
- 11.Bennett RC, Hughes ES. Urinary calculi and ulcerative colitis. Br Med J. 1972;2(5812):494–6.PubMedPubMedCentralCrossRefGoogle Scholar
- 12.Knudsen L, Marcussen H, Fleckenstein P, Pedersen EB, Jarnum S. Urolithiasis in chronic inflammatory bowel disease. Scand J Gastroenterol. 1978;13(4):433–6.PubMedCrossRefGoogle Scholar
- 13.Gelzayd EA, Breuer RI, Kirsner JB. Nephrolithiasis in inflammatory bowel disease. Am J Dig Dis. 1968;13(12):1027–34.PubMedCrossRefGoogle Scholar
- 14.Maratka Z, Nedbal J. Urolithiasis as a complication of the surgical treatment of ulcerative colitis. Gut. 1964;5:214–7.PubMedPubMedCentralCrossRefGoogle Scholar
- 15.Mukewar S, Hall P, Lashner BA, et al. Risk factors for nephrolithiasis in patients with ileal pouches. Colitis. 2013;7(1):70–8.CrossRefGoogle Scholar
- 16.Arora Z, Mukewar S, Lopez R, et al. Etiopathogenesis of nephrolithiasis in ulcerative colitis patients with the ileal pouch anal anastomosis. Inflamm Bowel Dis. 2017;23(5):840–6.PubMedCrossRefGoogle Scholar
- 17.Levitt MD, Kuan M. The physiology of ileo-anal pouch function. Am J Surg. 1998;176:384–9.PubMedCrossRefGoogle Scholar
- 18.Schouten WR. Pouchitis. Mediat Inflamm. 1998;7:175–81.CrossRefGoogle Scholar
- 19.Figge HL. Calcium kidney stones: pathogenesis, evaluation and treatment options. US Pharm. 2011;36:HS32–6.Google Scholar
- 20.Mandel N. Mechanism of stone formation. Semin Nephrol. 1996;16:364–74.PubMedGoogle Scholar
- 21.Hessov I, Hasselblad C, Fasth S, et al. Magnesium deficiency after ileal resections for Crohn’s disease. Scand J Gastroenterol. 1983;18:643–9.PubMedCrossRefGoogle Scholar
- 22.Mcconnell N, Campbell S, Gillanders I. Risk factors for developing renal stones in inflammatory bowel disease. BJU Int. 2002;89:835–41.PubMedCrossRefGoogle Scholar
- 23.Parks JH, Worcester EM, O’Connor RC, et al. Urine stone risk factors in nephrolithiasis patients with and without bowel disease. Kidney Int. 2003;63(1):255–65.PubMedCrossRefGoogle Scholar
- 24.Hamm LL, Hering-Smith KS. Pathophysiology of hypocitraturic nephrolithiasis. Endocrinol Metab Clin N Am. 2002;31:885–93.CrossRefGoogle Scholar
- 25.Moe OW. Kidney stones: pathophysiology and medical management. Lancet. 2006;367(9507):333–44.PubMedCrossRefGoogle Scholar
- 26.Smith LH, Hofman AF, McCall JT, et al. Secondary hyperoxaluria in patients with ileal resection and oxalate nephrolithiasis. Clin Res. 1970;18:541.Google Scholar
- 27.Admirand WH, Earnest DL, Williams HE. Hyperoxaluria and bowel disease. Trans Assoc Am Phys. 1971;84:307–12.PubMedGoogle Scholar
- 28.Dowling RH, Rose GA, Sutor DJ. Hyperoxaluria and renal calculi in ileal disease. Lancet. 1971;1:1103–6.PubMedCrossRefGoogle Scholar
- 29.Earnest DL, Johnson G, Williams HE, et al. Hyperoxaluria in patients with ileal resection: an abnormality in dietary oxalate absorption. Gastroenterology. 1974;66:1114–22.PubMedGoogle Scholar
- 30.Stauffer JQ, Humphreys MH, Weir GJ. Acquired hyperoxaluria with regional enteritis after ileal resection. Annals Intern Med. 1973;79:383–91.CrossRefGoogle Scholar
- 31.Andersson H, Jagenburg R. Fat-reduced diet in the treatment of hyperoxaluria in patients with ileopathy. Gut. 1974;15:360–6.PubMedPubMedCentralCrossRefGoogle Scholar
- 32.Dobbins JW, Binder HJ. Importance of the colon in enteric hyperoxaluria. N Engl J Med. 1977;296:298–301.PubMedCrossRefGoogle Scholar
- 33.McDonald GB, Earnest DL, Admirand WH. Hyperoxaluria correlates with fat malabsorption in patients with sprue. Gut. 1977;18:561–6.PubMedPubMedCentralCrossRefGoogle Scholar
- 34.Modigliani R, LaBayle D, Aymes C, et al. Evidence for excessive absorption of oxalate by the colon in enteric hyperoxaluria. Scand J Gastroenterol. 1978;13:187–92.PubMedCrossRefGoogle Scholar
- 35.Stauffer JQ. Hyperoxaluria and intestinal disease: the role of steatorrhea and dietary calcium in regulating intestinal oxalate absorption. Am J Dig Dis. 1977;22:921–8.PubMedCrossRefGoogle Scholar
- 36.Earnest DL, Williams HE, Admirand WH. Treatment of enteric hyperoxaluria with calcium and medium chain triglyceride. Clin Res. 1975;23:130A.Google Scholar
- 37.Allison MJ, Cook HM, Milne DB, et al. Oxalate degradation by gastrointestinal bacteria from humans. J Nutr. 1986;116:455–60.PubMedCrossRefGoogle Scholar
- 38.Allison MJ, Daniel SL, Cornick NA. Oxalate degrading bacteria. In: Khan SR, editor. Calcium oxalate in biological systems. Boca Raton: CRC Press; 1995. p. 131–68.Google Scholar
- 39.Kumar R, Ghoshal UC, Singh G, Mittal RD. Infrequency of colonization with Oxalobacter formigenes in inflammatory bowel disease: possible role in renal stone formation. J Gastroenterol Hepatol. 2004;19:1403–9.PubMedCrossRefGoogle Scholar
- 40.Argenzio RA, Liacos JA, Allison MJ. Intestinal oxalate-degrading bacteria reduce oxalate absorption and toxicity in guinea pigs. J Nutr. 1988;228:787–92.CrossRefGoogle Scholar
- 41.Dobbins JW, Binder HJ. Effect of bile salts and fatty acids on the colonic absorption of oxalate. Gastroenterology. 1976;70:1096–100.PubMedCrossRefGoogle Scholar
- 42.Kathpalia SC, Favus MJ, Coe FL. Evidence for size and charge permselectivity of rat ascending colon. Effects of ricinoleate and bile salts on oxalic acid and neutral sugar transport. J Clin Invest. 1984;74:805–11.PubMedPubMedCentralCrossRefGoogle Scholar
- 43.Hofmann AF, Poley JR. Role of bile acid malabsorption in pathogenesis of diarrhea and steatorrhea in patients with ileal resection. Gastroenterology. 1972;62:918–34.PubMedCrossRefGoogle Scholar
- 44.Fairclough PD, Feest TG, Chadwick VS, et al. Effect of sodium chenodeoxycholate on oxalate absorption from the excluded human colon—a mechanism for enteric hyperoxaluria. Gut. 1977;18:240–4.PubMedPubMedCentralCrossRefGoogle Scholar
- 45.McLeod RS, Churchill DN. Urolithiasis complicating inflammatory bowel disease. J Urol. 1992;148:974–8.PubMedCrossRefGoogle Scholar
- 46.Demoulin N, Issa Z, Crott R, Morelle J, Danse E, Wallemacq P, Jadoul M, Deprez PH. Enteric hyperoxaluria in chronic pancreatitis. Medicine. 2017;96:19.CrossRefGoogle Scholar
- 47.Chen CH, Lin CL, Jeng LB. Association between chronic pancreatitis and urolithiasis: a population-based cohort study. PLoS One. 2018;13(3):e0194019.PubMedPubMedCentralCrossRefGoogle Scholar
- 48.Ciacci C, Spagnuolo G, Tortora R, Bucci C, Franzese D, Zingone F, Cirillo M. Urinary stone disease in adults with celiac disease: prevalence, incidence and urinary determinants. J Urol. 2008;180:974–9.PubMedCrossRefGoogle Scholar
- 49.Saccomani MD, Pizzini C, Piacentini GL, Boner AL, Peroni DG. Analysis of urinary parameters as risk factors for nephrolithiasis in children with celiac disease. J Urol. 2012;188:566–70.PubMedCrossRefGoogle Scholar
- 50.Kramer P. Effect of specific foods, beverages, and spices on amount of ileostomy output in human subjects. Am J Gastroenterol. 1987;82:327–32.PubMedGoogle Scholar
- 51.Soybel DI. Adaptation to ileal diversion. Surgery. 2001;129:123–7.PubMedCrossRefGoogle Scholar
- 52.Metcalf AM, Phillips SF. Ileostomy diarrhoea. Clin Gastroenterol. 1986;15:705–22.PubMedGoogle Scholar
- 53.Higham SE, Read NW. Effect of ingestion of fat on ileostomy effluent. Gut. 1990;31:435–8.PubMedPubMedCentralCrossRefGoogle Scholar
- 54.Ladas SD, Isaacs PE, Murphy GM, et al. Fasting and post-prandial ileal function in adapted ileostomates and normal subjects. Gut. 1986;27:906–12.PubMedPubMedCentralCrossRefGoogle Scholar
- 55.Hallgren T, Oresland T, Anderson H, et al. Ileostomy output and bile acid excretion after intraduodenal administration of oleic acid. Scand J Gastroenterol. 1994;29:1017–23.PubMedCrossRefGoogle Scholar
- 56.Tytgat GN, Huibregtse K, Meuwissen SG. Loperamide in chronic diarrhea and after ileostomy: a placebo-controlled double-blind cross-over study. Arch Chir Neerl. 1976;28:13–20.PubMedGoogle Scholar
- 57.King RF, Norton T, Hill GL. A double-blind crossover study of the effect of loperamide hydrochloride and codeine phosphate on ileostomy output. Aust N Z J Surg. 1982;52:121–4.PubMedCrossRefGoogle Scholar
- 58.Newton CR. The effect of codeine phosphate, Lomotil and Isogel on ileostomy function. Gut. 1973;14:424–5.PubMedGoogle Scholar
- 59.Bonvalet JP. Regulation of sodium transport by steroid hormones. Kidney Int. 1998;53:49–56.Google Scholar
- 60.Scheurlen C, Allgayer H, Hardt M, et al. Effect of short-term topical corticosteroid treatment on mucosal enzyme systems in patients with distal inflammatory bowel disease. Hepato-Gastroenterology. 1998;45:1539–45.PubMedGoogle Scholar
- 61.Sellin JH, DeSoignie RC. Steroids alter ion transport and absorptive capacity in proximal and distal colon. Am J Phys. 1985;249:G113–9.Google Scholar
- 62.Ecker KW, Stallmach A, Seitz G, et al. Oral budesonide significantly improves water absorption in patients with ileostomy for Crohn’s disease. Scand J Gastroenterol. 2003;38(3):288–93.PubMedCrossRefGoogle Scholar
- 63.Rodrigues CA, Lennard-Jones JE, Thompson DG, Farthing MJ. The effects of octreotide, soy polysaccharide, codeine and loperamide on nutrient, fluid and electrolyte absorption in the short-bowel syndrome. Aliment Pharmacol Ther. 1989;3:159–69.PubMedCrossRefGoogle Scholar
- 64.Cooper JC, Williams NS, King RF, Barker MC. Effects of a long acting somatostatin analogue in patients with severe ileostomy diarrhoea. Br J Surg. 1986;73:128–31.PubMedCrossRefGoogle Scholar
- 65.Ladefoged K, Christensen KC, Hegnhoj J, et al. Effect of a long acting somatostatin analogue SMS 201-995 on jejunostomy effluents in patients with severe short bowel syndrome. Gut. 1989;30:943–9.PubMedPubMedCentralCrossRefGoogle Scholar
- 66.Fedorak RN, Field M, Chang EB. Treatment of diabetic diarrhea with clonidine. Ann Intern Med. 1985;102:197–9.PubMedCrossRefGoogle Scholar
- 67.Scholz J, Bause H, Reymann A, Durig M. Treatment with clonidine in a case of the short bowel syndrome with therapy-refractory diarrhea. Anasthesiol Intensivmed Notfallmed Schmerzther. 1991;26:265–9.PubMedCrossRefGoogle Scholar
- 68.McDoniel K, Taylor B, Huey W, et al. Use of clonidine to decrease intestinal fluid losses in patients with high-output short-bowel syndrome. JPEN J Parenter Enteral Nutr. 2004;28:265–8.PubMedCrossRefGoogle Scholar
- 69.Fukushima T, Yamazaki Y, Sugita A, et al. Prophylaxis of uric acid stone in patients with inflammatory bowel disease following extensive colonic resection. Gastroenterol Jpn. 1991;26:430–4.PubMedCrossRefGoogle Scholar
- 70.Reisner GS, Wilansky DL, Schneiderman C. Uric acid lithiasis in the ileostomy patient. Br J Urol. 1973;45:340–3.PubMedCrossRefGoogle Scholar