Metabolic profile and impact of diet in patients with primary hyperoxaluria

Siener, Roswitha; Höppe, Bernd; Löhr, Patricia; Müller, Stefan; Latz, Stefan

doi:10.1007/s11255-018-1939-1

Cited by 18 publications

(11 citation statements)

References 26 publications

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“…It was recently described (contrary to current opinion) that patients with PH may benefit from a restriction of food with extremely high oxalate content [ 36 ]. In our analysis, we only observed a slight increase in oxalate levels (of ≤ 15%) under the oxalate-rich diet, which is, however, in the range of the normal variability of oxalate levels in urine [ 30 , 31 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

Diet-related urine collections: assistance in categorization of hyperoxaluria

2021

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Hyperoxaluria, one of the major risk factors for calcium oxalate urolithiasis and nephrocalcinosis, causes significant morbidity and mortality and should therefore be detected and treated as soon as possible. An early, consequent and adequate evaluation, but also a distinction between primary (PH) and secondary hyperoxaluria (SH) is therefore essential. We evaluated the usefulness of three consecutive 24-h urine collections under different diets [usual diet, (A), low oxalate diet, (B), high oxalate diet, (C)] to prove SH, or to find evidence of PH by changes in urinary oxalate excretion (Uox). We retrospectively analyzed results from 96 pediatric patients (47 females and 49 males, age 3–18 years) who presented with a history of nephrolithiasis, nephrocalcinosis and/or persistent hematuria in whom hyperoxaluria was found in an initial urine sample. The typical pattern of SH was found in 34 patients (mean Uox (A) 0.85 ± 0.29, (B) 0.54 ± 0.15 and (C) 0.95 ± 0.28 mmol/1.73m2/d). PH was suspected in 13 patients [(A) 1.21 ± 0.75; (B) 1.47 ± 0.51 and (C) 1.60 ± 0.82 mmol/1.73m2/d], but genetically proven only in 1/5 patients examined. No hyperoxaluria was found in 16 patients. Data were inconclusive in 33 patients. Urine collection under different diets is helpful to diagnose secondary hyperoxaluria and may provide evidence, that urinary oxalate excretion is normal. We have now established this procedure as our first diagnostic step before further, more extensive and more expensive evaluations are performed.

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Section: Discussionmentioning

confidence: 99%

Diet-related urine collections: assistance in categorization of hyperoxaluria

2021

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“…A study under controlled dietary conditions noted a significant increase in urinary oxalate in both calcium oxalate stone patients and healthy controls after oral supplementation of 2 g ascorbic acid daily [148]. Dietary hydroxyproline, mainly present in collagen/gelatin, may also contribute to endogenous oxalate synthesis and urinary oxalate excretion in healthy subjects and in primary hyperoxaluria [135,149,150]. A study using infusions of [ 15 N, 13 C 5 ]-hydroxyproline found that hydroxyproline contributed at least 15% to urinary oxalate excretion in healthy volunteers and could be a major source of the oxalate produced in patients with primary hyperoxaluria [149,150].…”

Section: Oxalatementioning

confidence: 99%

Nutrition and Kidney Stone Disease

Siener

2021

Nutrients

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The prevalence of kidney stone disease is increasing worldwide. The recurrence rate of urinary stones is estimated to be up to 50%. Nephrolithiasis is associated with increased risk of chronic and end stage kidney disease. Diet composition is considered to play a crucial role in urinary stone formation. There is strong evidence that an inadequate fluid intake is the major dietary risk factor for urolithiasis. While the benefit of high fluid intake has been confirmed, the effect of different beverages, such as tap water, mineral water, fruit juices, soft drinks, tea and coffee, are debated. Other nutritional factors, including dietary protein, carbohydrates, oxalate, calcium and sodium chloride can also modulate the urinary risk profile and contribute to the risk of kidney stone formation. The assessment of nutritional risk factors is an essential component in the specific dietary therapy of kidney stone patients. An appropriate dietary intervention can contribute to the effective prevention of recurrent stones and reduce the burden of invasive surgical procedures for the treatment of urinary stone disease. This narrative review has intended to provide a comprehensive and updated overview on the role of nutrition and diet in kidney stone disease.

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“…Dietary changes have traditionally been thought to be irrelevant in PH1, as the fraction of dietary oxalate excreted into urine is very low (<5%) 31 . However, a 2018 study demonstrated that decreased oxalate and hydroxyproline dietary intake leads to reduced urinary oxalate excretion in some patients 32 . Citrate compounds (such as potassium citrate and sodium citrate), commonly prescribed to treat kidney stone disease, inhibit crystallization by binding available free calcium and alkalizing urine 33 .…”

Section: Traditional Management Optionsmentioning

confidence: 99%

Perspectives in primary hyperoxaluria — historical, current and future clinical interventions

Shee

Stoller

2021

Nat Rev Urol

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Primary hyperoxalurias are a devastating family of diseases leading to multisystem oxalate deposition, nephrolithiasis, nephrocalcinosis and end-stage renal disease. Traditional treatment paradigms are limited to conservative management, dialysis and combined transplantation of the kidney and liver, of which the liver is the primary source of oxalate production. However, transplantation is associated with many potential complications, including operative risks, graft rejection, post-transplant organ failure, as well as lifelong immunosuppressive medications and their adverse effects. New therapeutics being developed for primary hyperoxalurias take advantage of biochemical knowledge about oxalate synthesis and metabolism, and seek to specifically target these pathways with the goal of decreasing the accumulation and deposition of oxalate in the body.

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Metabolic profile and impact of diet in patients with primary hyperoxaluria

Abstract: Our pilot data indicate that patients with PH may benefit from a restriction of dietary oxalate and hydroxyproline intake. Further research is needed to define the role of distal RTA in PH and to evaluate the hypothesis of an acquired acidification defect.

Cited by 18 publications

References 26 publications

Diet-related urine collections: assistance in categorization of hyperoxaluria

Diet-related urine collections: assistance in categorization of hyperoxaluria

Nutrition and Kidney Stone Disease

Perspectives in primary hyperoxaluria — historical, current and future clinical interventions

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