Advertisement

Nephrolithiasis in Patients with Gastrointestinal Disorders

  • Gebran AbboudEmail author
Chapter
First Online:
Part of the Nutrition and Health book series (NH)

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 Hyperoxaluria 
This is a preview of subscription content, log in to check access.

References

  1. 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. 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. 3.
    Clarke AM, McKenzie RG. Ileostomy and the risk of urinary uric acid stones. Lancet. 1969;2:395–7.PubMedCrossRefGoogle Scholar
  4. 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. 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. 6.
    Ingimarsson JP, Krambeck AE, Pais VM. Diagnosis and management of nephrolithiasis. Surg Clin North Am. 2016;96(3):517–32.PubMedCrossRefGoogle Scholar
  7. 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. 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. 9.
    Galland L. Magnesium and inflammatory bowel disease. Magnesium. 1988;7:78–83.PubMedGoogle Scholar
  10. 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. 11.
    Bennett RC, Hughes ES. Urinary calculi and ulcerative colitis. Br Med J. 1972;2(5812):494–6.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 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. 13.
    Gelzayd EA, Breuer RI, Kirsner JB. Nephrolithiasis in inflammatory bowel disease. Am J Dig Dis. 1968;13(12):1027–34.PubMedCrossRefGoogle Scholar
  14. 14.
    Maratka Z, Nedbal J. Urolithiasis as a complication of the surgical treatment of ulcerative colitis. Gut. 1964;5:214–7.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 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. 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. 17.
    Levitt MD, Kuan M. The physiology of ileo-anal pouch function. Am J Surg. 1998;176:384–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Schouten WR. Pouchitis. Mediat Inflamm. 1998;7:175–81.CrossRefGoogle Scholar
  19. 19.
    Figge HL. Calcium kidney stones: pathogenesis, evaluation and treatment options. US Pharm. 2011;36:HS32–6.Google Scholar
  20. 20.
    Mandel N. Mechanism of stone formation. Semin Nephrol. 1996;16:364–74.PubMedGoogle Scholar
  21. 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. 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. 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. 24.
    Hamm LL, Hering-Smith KS. Pathophysiology of hypocitraturic nephrolithiasis. Endocrinol Metab Clin N Am. 2002;31:885–93.CrossRefGoogle Scholar
  25. 25.
    Moe OW. Kidney stones: pathophysiology and medical management. Lancet. 2006;367(9507):333–44.PubMedCrossRefGoogle Scholar
  26. 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. 27.
    Admirand WH, Earnest DL, Williams HE. Hyperoxaluria and bowel disease. Trans Assoc Am Phys. 1971;84:307–12.PubMedGoogle Scholar
  28. 28.
    Dowling RH, Rose GA, Sutor DJ. Hyperoxaluria and renal calculi in ileal disease. Lancet. 1971;1:1103–6.PubMedCrossRefGoogle Scholar
  29. 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. 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. 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. 32.
    Dobbins JW, Binder HJ. Importance of the colon in enteric hyperoxaluria. N Engl J Med. 1977;296:298–301.PubMedCrossRefGoogle Scholar
  33. 33.
    McDonald GB, Earnest DL, Admirand WH. Hyperoxaluria correlates with fat malabsorption in patients with sprue. Gut. 1977;18:561–6.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 45.
    McLeod RS, Churchill DN. Urolithiasis complicating inflammatory bowel disease. J Urol. 1992;148:974–8.PubMedCrossRefGoogle Scholar
  46. 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. 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. 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. 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. 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. 51.
    Soybel DI. Adaptation to ileal diversion. Surgery. 2001;129:123–7.PubMedCrossRefGoogle Scholar
  52. 52.
    Metcalf AM, Phillips SF. Ileostomy diarrhoea. Clin Gastroenterol. 1986;15:705–22.PubMedGoogle Scholar
  53. 53.
    Higham SE, Read NW. Effect of ingestion of fat on ileostomy effluent. Gut. 1990;31:435–8.PubMedPubMedCentralCrossRefGoogle Scholar
  54. 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. 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. 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. 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. 58.
    Newton CR. The effect of codeine phosphate, Lomotil and Isogel on ileostomy function. Gut. 1973;14:424–5.PubMedGoogle Scholar
  59. 59.
    Bonvalet JP. Regulation of sodium transport by steroid hormones. Kidney Int. 1998;53:49–56.Google Scholar
  60. 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. 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. 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. 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. 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. 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. 66.
    Fedorak RN, Field M, Chang EB. Treatment of diabetic diarrhea with clonidine. Ann Intern Med. 1985;102:197–9.PubMedCrossRefGoogle Scholar
  67. 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. 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. 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. 70.
    Reisner GS, Wilansky DL, Schneiderman C. Uric acid lithiasis in the ileostomy patient. Br J Urol. 1973;45:340–3.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Conemaugh Memorial Medical CenterJohnstownUSA

Personalised recommendations

Cite chapter

Buy options