eMedicine Specialties > Urology > Stones

Hyperoxaluria: Follow-up

Author: Bijan Shekarriz, MD, Director, Laparoscopy and Minimally Invasive Surgery, Associate Professor of Urology, Department of Urology, State University of New York Upstate Medical University
Coauthor(s): Marshall L Stoller, MD, Medical Director of Urinary Stone Center, Professor, Department of Urology, University of California at San Francisco
Contributor Information and Disclosures

Updated: Nov 16, 2009

Follow-up

Complications

  • All forms of hyperoxaluria are associated with recurrent urolithiasis.
  • Primary hyperoxaluria may result in renal failure due to nephrocalcinosis.

Prognosis

  • The prognosis of enteric and mild hyperoxaluria is favorable if medical management and dietary modifications are followed. Periodic retesting using 24-hour urine assessments should be performed regularly to monitor compliance and treatment effectiveness.
  • The prognosis of primary hyperoxaluria depends on early treatment and management of hyperoxaluria and associated renal deterioration. If medical treatment cannot help the patient maintain a normal oxalate level, nephrocalcinosis may develop, with subsequent renal failure. In this situation, combined liver-renal transplantation is necessary for cure.

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More on Hyperoxaluria

Overview: Hyperoxaluria
Differential Diagnoses & Workup: Hyperoxaluria
Treatment & Medication: Hyperoxaluria
Follow-up: Hyperoxaluria
Multimedia: Hyperoxaluria
References
Further Reading
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References

  1. Sidhu H, Schmidt ME, Cornelius JG, Thamilselvan S, Khan SR, Hesse A, et al. 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. Nov 1999;10 Suppl 14:S334-40. [Medline].

  2. Troxel SA, Sidhu H, Kaul P, Low RK. Intestinal Oxalobacter formigenes colonization in calcium oxalate stone formers and its relation to urinary oxalate. J Endourol. Apr 2003;17(3):173-6. [Medline].

  3. Baggio B, Gambaro G, Marchini F, Cicerello E, Tenconi R, Clementi M, et al. An inheritable anomaly of red-cell oxalate transport in "primary" calcium nephrolithiasis correctable with diuretics. N Engl J Med. Mar 6 1986;314(10):599-604. [Medline].

  4. Lewandowski S, Rodgers A, Schloss I. The influence of a high-oxalate/low-calcium diet on calcium oxalate renal stone risk factors in non-stone-forming black and white South African subjects. BJU Int. Mar 2001;87(4):307-11. [Medline].

  5. Rodgers AL, Lewandowski S. Effects of 5 different diets on urinary risk factors for calcium oxalate kidney stone formation: evidence of different renal handling mechanisms in different race groups. J Urol. Sep 2002;168(3):931-6. [Medline].

  6. Powell CR, Stoller ML, Schwartz BF, Kane C, Gentle DL, Bruce JE, et al. Impact of body weight on urinary electrolytes in urinary stone formers. Urology. Jun 2000;55(6):825-30. [Medline].

  7. Iguchi M, Takamura C, Umekawa T, Kurita T, Kohri K. Inhibitory effects of female sex hormones on urinary stone formation in rats. Kidney Int. Aug 1999;56(2):479-85. [Medline].

  8. Fan J, Chandhoke PS, Grampsas SA. Role of sex hormones in experimental calcium oxalate nephrolithiasis. J Am Soc Nephrol. Nov 1999;10 Suppl 14:S376-80. [Medline].

  9. Fan J, Glass MA, Chandhoke PS. Effect of castration and finasteride on urinary oxalate excretion in male rats. Urol Res. 1998;26(1):71-5. [Medline].

  10. Holmes RP, Goodman HO, Assimos DG. Contribution of dietary oxalate to urinary oxalate excretion. Kidney Int. Jan 2001;59(1):270-6. [Medline].

  11. Khan SR, Glenton PA, Byer KJ. Dietary oxalate and calcium oxalate nephrolithiasis. J Urol. Nov 2007;178(5):2191-6. [Medline].

  12. Massey LK, Roman-Smith H, Sutton RA. Effect of dietary oxalate and calcium on urinary oxalate and risk of formation of calcium oxalate kidney stones. J Am Diet Assoc. Aug 1993;93(8):901-6. [Medline].

  13. Nguyen QV, Kalin A, Drouve U, Casez JP, Jaeger P. Sensitivity to meat protein intake and hyperoxaluria in idiopathic calcium stone formers. Kidney Int. Jun 2001;59(6):2273-81. [Medline].

  14. Milliner DS, Eickholt JT, Bergstralh EJ, Wilson DM, Smith LH. Results of long-term treatment with orthophosphate and pyridoxine in patients with primary hyperoxaluria. N Engl J Med. Dec 8 1994;331(23):1553-8. [Medline].

  15. Lindsjö M, Fellstrom B, Ljunghall S, Wikström B, Danielson BG. Treatment of enteric hyperoxaluria with calcium-containing organic marine hydrocolloid. Lancet. Sep 23 1989;2(8665):701-4. [Medline].

  16. Adhirai M, Selvam R. Effect of cyclosporin on liver antioxidants and the protective role of vitamin E in hyperoxaluria in rats. J Pharm Pharmacol. May 1998;50(5):501-5. [Medline].

  17. Selvam R, Ravichandran V. Restoration of tissue antioxidants and prevention of renal stone deposition in vitamin B6 deficient rats fed with vitamin E or methionine. Indian J Exp Biol. Nov 1993;31(11):882-7. [Medline].

  18. Siener R, Ebert D, Hesse A. Urinary oxalate excretion in female calcium oxalate stone formers with and without a history of recurrent urinary tract infections. Urol Res. Aug 2001;29(4):245-8. [Medline].

  19. Sidhu H, Hoppe B, Hesse A, Tenbrock K, Bromme S, Rietschel E, et al. Absence of Oxalobacter formigenes in cystic fibrosis patients: a risk factor for hyperoxaluria. Lancet. Sep 26 1998;352(9133):1026-9. [Medline].

  20. Poonguzhali PK, Chegu H. The influence of banana stem extract on urinary risk factors for stones in normal and hyperoxaluric rats. Br J Urol. Jul 1994;74(1):23-5. [Medline].

  21. Ramakrishnan V, Lathika KM, D'Souza SJ, Singh BB, Raghavan KG. Investigation with chitosan-oxalate oxidase-catalase conjugate for degrading oxalate from hyperoxaluric rat chyme. Indian J Biochem Biophys. Aug 1997;34(4):373-8. [Medline].

  22. Malini MM, Baskar R, Varalakshmi P. Effect of lupeol, a pentacyclic triterpene, on urinary enzymes in hyperoxaluric rats. Jpn J Med Sci Biol. Oct-Dec 1995;48(5-6):211-20. [Medline].

  23. Saravanan N, Senthil D, Varalakshmi P. Effect of L-cysteine on some urinary risk factors in experimental hyperoxaluric rats. Br J Urol. Jul 1996;78(1):22-4. [Medline].

  24. Brandle E, Bernt U, Kleinschmidt K. EO8 a specific inhibitor of the renal tubular oxalate secretion - a new concept in the medical treatment of calcium oxalate stones. J Urol. 1999;161(4):248.

  25. Straub M, Befolo-Elo J, Hautmann R, et al. Does the renal-tubular oxalate excretion depend on urinary-pH?. J Urol. 2002;167(4):257-8.

  26. Asplin JR, Coe FL. Hyperoxaluria in kidney stone formers treated with modern bariatric surgery. J Urol. Feb 2007;177(2):565-9. [Medline].

  27. Bobrowski AE, Langman CB. Hyperoxaluria and systemic oxalosis: current therapy and future directions. Expert Opin Pharmacother. Oct 2006;7(14):1887-96. [Medline].

  28. Brändle E, Bernt U, Hautmann RE. In situ characterization of oxalate transport across the basolateral membrane of the proximal tubule. Pflugers Arch. May 1998;435(6):840-9. [Medline].

  29. Cochat P. Primary hyperoxaluria type 1. Kidney Int. Jun 1999;55(6):2533-47. [Medline].

  30. Cochat P, Basmaison O. Current approaches to the management of primary hyperoxaluria. Arch Dis Child. Jun 2000;82(6):470-3. [Medline].

  31. Cochat P, Koch Nogueira PC, Mahmoud MA, Jamieson NV, Scheinman JI, Rolland MO. Primary hyperoxaluria in infants: medical, ethical, and economic issues. J Pediatr. Dec 1999;135(6):746-50. [Medline].

  32. Curhan GC. Epidemiologic evidence for the role of oxalate in idiopathic nephrolithiasis. J Endourol. Nov 1999;13(9):629-31. [Medline].

  33. Curhan GC, Willett WC, Speizer FE, Stampfer MJ. Intake of vitamins B6 and C and the risk of kidney stones in women. J Am Soc Nephrol. Apr 1999;10(4):840-5. [Medline].

  34. Curhan GC, Willett WC, Speizer FE, Stampfer MJ. Twenty-four-hour urine chemistries and the risk of kidney stones among women and men. Kidney Int. Jun 2001;59(6):2290-8. [Medline].

  35. Drach G, Malone W. Toxicity of common houseplant. JAMA. 1963;184:1047-8.

  36. Erturk E, Kiernan M, Schoen SR. Clinical association with urinary glycosaminoglycans and urolithiasis. Urology. Apr 2002;59(4):495-9. [Medline].

  37. Fellström B, Backman U, Danielson B, Wikström B. Treatment of renal calcium stone disease with the synthetic glycosaminoglycan pentosan polysulphate. World J Urol. 1994;12(1):52-4. [Medline].

  38. Gentle DL, Stoller ML, Bruce JE, Leslie SW. Geriatric urolithiasis. J Urol. Dec 1997;158(6):2221-4. [Medline].

  39. Goldfarb DS, Modersitzki F, Asplin JR. A randomized, controlled trial of lactic acid bacteria for idiopathic hyperoxaluria. Clin J Am Soc Nephrol. Jul 2007;2(4):745-9. [Medline].

  40. Goldfarb DS, Parks JH, Coe FL. Renal stone disease in older adults. Clin Geriatr Med. May 1998;14(2):367-81. [Medline].

  41. Hatch M, Freel RW, Vaziri ND. Intestinal excretion of oxalate in chronic renal failure. J Am Soc Nephrol. Dec 1994;5(6):1339-43. [Medline].

  42. Hatch M, Freel RW, Vaziri ND. Regulatory aspects of oxalate secretion in enteric oxalate elimination. J Am Soc Nephrol. Nov 1999;10 Suppl 14:S324-8. [Medline].

  43. Hess B, Jost C, Zipperle L, Takkinen R, Jaeger P. High-calcium intake abolishes hyperoxaluria and reduces urinary crystallization during a 20-fold normal oxalate load in humans. Nephrol Dial Transplant. Sep 1998;13(9):2241-7. [Medline].

  44. Holmes RP, Assimos DG. Glyoxylate synthesis, and its modulation and influence on oxalate synthesis. J Urol. Nov 1998;160(5):1617-24. [Medline].

  45. Hoppe B, Beck B, Gatter N, von Unruh G, Tischer A, Hesse A, et al. Oxalobacter formigenes: a potential tool for the treatment of primary hyperoxaluria type 1. Kidney Int. Oct 2006;70(7):1305-11. [Medline].

  46. Hoppe B, Beck BB, Milliner DS. The primary hyperoxalurias. Kidney Int. Jun 2009;75(12):1264-71. [Medline].

  47. Hoppe B, Kemper MJ, Bokenkamp A, Portale AA, Cohn RA, Langman CB. Plasma calcium oxalate supersaturation in children with primary hyperoxaluria and end-stage renal failure. Kidney Int. Jul 1999;56(1):268-74. [Medline].

  48. Hoppe B, von Unruh G, Laube N, Hesse A, Sidhu H. Oxalate degrading bacteria: new treatment option for patients with primary and secondary hyperoxaluria?. Urol Res. Nov 2005;33(5):372-5. [Medline].

  49. Hoppe B, von Unruh GE, Blank G, Rietschel E, Sidhu H, Laube N, et al. Absorptive hyperoxaluria leads to an increased risk for urolithiasis or nephrocalcinosis in cystic fibrosis. Am J Kidney Dis. Sep 2005;46(3):440-5. [Medline].

  50. Kemper MJ. Concurrent or sequential liver and kidney transplantation in children with primary hyperoxaluria type 1?. Pediatr Transplant. Dec 2005;9(6):693-6. [Medline].

  51. Kwak C, Jeong BC, Lee JH, Kim HK, Kim EC, Kim HH. Molecular identification of Oxalobacter formigenes with the polymerase chain reaction in fresh or frozen fecal samples. BJU Int. Oct 2001;88(6):627-32. [Medline].

  52. Lee YH, Huang WC, Chiang H, Chen MT, Huang JK, Chang LS. Determinant role of testosterone in the pathogenesis of urolithiasis in rats. J Urol. Apr 1992;147(4):1134-8. [Medline].

  53. Leslie S. A practical approach to kidney stone prevention. Nephrolithiasis update: the role of metabolic evaluations. SUNA Annual Meeting Postgraduate Course Syllabus. 1996;12-14.

  54. Leslie S. Oxalate. In: Savitz G, Leslie S. The Kidney Stones Handbook. 2nd ed. Four Geez Press; 2000:95-104.

  55. Leslie S, Stoller M, Gentle D. Combined metabolic defects in stone forming patients. J Urol. 1997;157 (4 Suppl):413.

  56. Liebman M, Chai W. Effect of dietary calcium on urinary oxalate excretion after oxalate loads. Am J Clin Nutr. May 1997;65(5):1453-9. [Medline].

  57. Liebman M, Costa G. Effects of calcium and magnesium on urinary oxalate excretion after oxalate loads. J Urol. May 2000;163(5):1565-9. [Medline].

  58. Lieske JC, Goldfarb DS, De Simone C, Regnier C. Use of a probiotic to decrease enteric hyperoxaluria. Kidney Int. Sep 2005;68(3):1244-9. [Medline].

  59. Milliner D. Treatment of the primary hyperoxalurias: a new chapter. Kidney Int. Oct 2006;70(7):1198-200. [Medline].

  60. Mitwalli A, Ayiomamitis A, Grass L, Oreopoulos DG. Control of hyperoxaluria with large doses of pyridoxine in patients with kidney stones. Int Urol Nephrol. 1988;20(4):353-9. [Medline].

  61. Mukhin VN, Khomiakov KA. [Phenogenetics of offspring and their ancestors]. Tsitol Genet. Jul-Aug 2003;37(4):54-6. [Medline].

  62. Nemeh M, Weinman E, Kayne L, Lee D. Absorption and excretion of urate, oxalate and amino acids. In: Coe F, Favus M, Pak C, Parks J, Preminger G, eds. Kidney Stones: Medical and Surgical Management. Philadelphia, Pa: Lippincott-Raven; 1996:303-19.

  63. Nolkemper D, Kemper MJ, Burdelski M, Vaismann I, Rogiers X, Broelsch CE, et al. Long-term results of pre-emptive liver transplantation in primary hyperoxaluria type 1. Pediatr Transplant. Aug 2000;4(3):177-81. [Medline].

  64. Ogawa Y, Miyazato T, Hatano T. Oxalate and urinary stones. World J Surg. Oct 2000;24(10):1154-9. [Medline].

  65. Pais VM Jr, Assimos DG. Pitfalls in the management of patients with primary hyperoxaluria: a urologist's perspective. Urol Res. Nov 2005;33(5):390-3. [Medline].

  66. Rattan V, Sidhu H, Vaidyanathan S, Thind SK, Nath R. Effect of combined supplementation of magnesium oxide and pyridoxine in calcium-oxalate stone formers. Urol Res. 1994;22(3):161-5. [Medline].

  67. Senthil D, Malini MM, Varalakshmi P. Sodium pentosan polysulphate--a novel inhibitor of urinary risk factors and enzymes in experimental urolithiatic rats. Ren Fail. Jul 1998;20(4):573-80. [Medline].

  68. Senthil D, Subha K, Saravanan N, Varalakshmi P. Influence of sodium pentosan polysulphate and certain inhibitors on calcium oxalate crystal growth. Mol Cell Biochem. Mar 9 1996;156(1):31-5. [Medline].

  69. Straub M, Hautmann RE, Hesse A, Rinnab L. [Calcium oxalate stones and hyperoxaluria. What is certain? What is new?]. Urologe A. Nov 2005;44(11):1315-23. [Medline].

  70. Su CJ, Shevock PN, Khan SR, Hackett RL. Effect of magnesium on calcium oxalate urolithiasis. J Urol. May 1991;145(5):1092-5. [Medline].

  71. Takei K, Ito H, Masai M, Kotake T. Oral calcium supplement decreases urinary oxalate excretion in patients with enteric hyperoxaluria. Urol Int. 1998;61(3):192-5. [Medline].

  72. Terris MK, Issa MM, Tacker JR. Dietary supplementation with cranberry concentrate tablets may increase the risk of nephrolithiasis. Urology. Jan 2001;57(1):26-9. [Medline].

  73. Thamilselvan S, Byer KJ, Hackett RL, Khan SR. Free radical scavengers, catalase and superoxide dismutase provide protection from oxalate-associated injury to LLC-PK1 and MDCK cells. J Urol. Jul 2000;164(1):224-9. [Medline].

  74. Whitson JM, Stackhouse GB, Stoller ML. Hyperoxaluria after modern bariatric surgery: case series and literature review. Int Urol Nephrol. Jul 2 2009;[Medline].

  75. Worcester E. Stones due to bowel disease. In: Coe F, Favus M, Pak C, Parks J, Preminger G, eds. Kidney Stones: Medical and Surgical Management. Philadelphia, Pa: Lippincott-Raven; 1996:883-903.

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Further Reading

For additional information, see Medscape’s Stone Disease Resource Center.

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Keywords

hyperoxaluria, enteric hyperoxaluria, high urinary oxalate, excessive urinary oxalate, kidney stones, renal stones, nephrolithiasis, oxalosis, oxaluria, primary hyperoxaluria, urinary calculi, oxalic acid, calcium oxalate, nephrocalcinosis, extrarenal oxalosis, progressive renal failure, uremia, alanine-glyoxylate aminotransferase, AGT, AGXT gene, end-stage renal failure, hypocalciuria, hypocitraturia, primary hyperoxaluria, Oxalobacter, Oxalobacter formigenes, O formigenes, cholestyramine, kidney stone formation, dietary hyperoxaluria, idiopathic hyperoxaluria, mild hyperoxaluria, type I hyperoxaluria, type II hyperoxaluria

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Contributor Information and Disclosures

Author

Bijan Shekarriz, MD, Director, Laparoscopy and Minimally Invasive Surgery, Associate Professor of Urology, Department of Urology, State University of New York Upstate Medical University
Bijan Shekarriz, MD is a member of the following medical societies: American Urological Association and Endourological Society
Disclosure: Nothing to disclose.

Coauthor(s)

Marshall L Stoller, MD, Medical Director of Urinary Stone Center, Professor, Department of Urology, University of California at San Francisco
Marshall L Stoller, MD is a member of the following medical societies: American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Martha K Terris, MD, FACS, Professor, Department of Surgery, Medical College of Georgia
Martha K Terris, MD, FACS is a member of the following medical societies: American Cancer Society, American College of Surgeons, American Institute of Ultrasound in Medicine, American Urological Association, New York Academy of Sciences, and Society of University Urologists
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Gyrus-ACMI Honoraria Speaking and teaching

Chief Editor

Bradley Fields Schwartz, DO, FACS, Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine
Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Nothing to disclose.

 
 
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