Enteric hyperoxaluria: role of microbiota and antibiotics : Current Opinion in Nephrology and Hypertension (original) (raw)

RENAL PATHOPHYSIOLOGY: Edited by Orson W. Moe and Susan E. Quaggin

role of microbiota and antibiotics

aDivision of Nephrology, Department of Medicine

bSackler Institute of Graduate Biomedical Sciences, New York University Langone Health, New York, NY, USA

Correspondence to Lama Nazzal, MD, MSc, Assistant Professor, Nephrology Section, New York University School of Medicine, 550 first avenue, OBV A600, New York, NY 10016, USA. Tel: +1 212 263 2922; e-mail: [email protected]

Current Opinion in Nephrology and Hypertension 28(4):p 352-359, July 2019. | DOI: 10.1097/MNH.0000000000000518

Abstract

Purpose of review

Enteric hyperoxaluria is commonly observed in malabsorptive conditions including Roux en Y gastric bypass (RYGB) and inflammatory bowel diseases (IBD). Its incidence is increasing secondary to an increased prevalence of both disorders. In this review, we summarize the evidence linking the gut microbiota to the risk of enteric hyperoxaluria.

Recent findings

In enteric hyperoxaluria, fat malabsorption leads to increased binding of calcium to free fatty acids resulting in more soluble oxalate in the intestinal lumen. Bile acids and free fatty acids in the lumen also cause increased gut permeability allowing more passive absorption of oxalate. In recent years, there is more interest in the role of the gut microbiota in modulating urinary oxalate excretion in enteric hyperoxaluria, stemming from our knowledge that microbiota in the intestines can degrade oxalate. Oxalobacter formigenes reduced urinary oxalate in animal models of RYGB. The contribution of other oxalate-degrading organisms and the microbiota community to the pathophysiology of enteric hyperoxaluria are also currently under investigation.

Summary

Gut microbiota might play a role in modulating the risk of enteric hyperoxaluria through oxalate degradation and bile acid metabolism. O. formigenes is a promising therapeutic target in this population; however, further studies in humans are needed to test its effectiveness.