Metabolic profile and impact of diet in patients with primary hyperoxaluria (original) (raw)

Abstract

Purpose

The primary goal of this pilot study was to evaluate metabolic characteristics and to examine the impact of diet in patients with primary hyperoxaluria (PH) under controlled, standardized conditions.

Methods

Four patients with genetically confirmed PH collected 24 h urines on their habitual, self-selected diets and on day 1, 6, 7, 8, and 11 under controlled, standardized conditions. The [13C2]oxalate absorption, calcium, and ammonium chloride loading tests were performed.

Results

While none of the patients had abnormal findings from the calcium loading test, incomplete distal renal tubular acidosis (RTA) was diagnosed in each of the four patients. Dietary intervention resulted in a significant decrease in urinary oxalate expressed as molar creatinine ratio (mmol/mol) between 30 and 40% in two of four patients. The evaluation of dietary records revealed a high daily intake of oxalate-rich foods as well as gelatin-containing sweets and meat products, rich sources of hydroxyproline, under the habitual, self-selected diets of the two responders. Intestinal oxalate hyperabsorption of 12.4% in one of the two patients may have additionally contributed to the increased urinary oxalate excretion under the individual diet.

Conclusions

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.

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References

  1. Hoppe B, Beck BB, Milliner DS (2009) The primary hyperoxalurias. Kidney Int 75:1264–1271
    Article PubMed PubMed Central CAS Google Scholar
  2. Ermer T, Eckardt KU, Aronson PS, Knauf F (2016) Oxalate, inflammasome, and progression of kidney disease. Curr Opin Nephrol Hypertens 25:363–371
    Article PubMed PubMed Central CAS Google Scholar
  3. Hesse A, Tiselius HG, Siener R, Hoppe B (2009) Urinary stones. Diagnosis, treatment, and prevention of recurrence, 3rd revised and enlarged edn. Karger, Basel
    Book Google Scholar
  4. Leumann E, Hoppe B, Neuhaus T, Blau N (1995) Efficacy of oral citrate administration in primary hyperoxaluria. Nephrol Dial Transplant 10(Suppl 8):14–16
    Article PubMed Google Scholar
  5. Hoppe B, Groothoff JW, Hulton SA, Cochat P, Niaudet P, Kemper MJ, Deschênes G, Unwin R, Milliner D (2011) Efficacy and safety of Oxalobacter formigenes to reduce urinary oxalate in primary hyperoxaluria. Nephrol Dial Transplant 26:3609–3615
    Article PubMed Google Scholar
  6. Hoyer-Kuhn H, Kohbrok S, Volland R, Franklin J, Hero B, Beck BB, Hoppe B (2014) Vitamin B6 in primary hyperoxaluria I: first prospective trial after 40 years of practice. Clin J Am Soc Nephrol 9:468–477
    Article PubMed PubMed Central Google Scholar
  7. Sikora P, von Unruh GE, Beck B, Feldkötter M, Zajaczkowska M, Hesse A, Hoppe B (2008) [13C2]oxalate absorption in children with idiopathic calcium oxalate urolithiasis or primary hyperoxaluria. Kidney Int 73:1181–1186
    Article PubMed CAS Google Scholar
  8. Siener R, Jahnen A, Hesse A (2004) Influence of a mineral water rich in calcium, magnesium and bicarbonate on urine composition and the risk of calcium oxalate crystallization. Eur J Clin Nutr 58:270–276
    Article PubMed CAS Google Scholar
  9. von Unruh GE, Voss S, Sauerbruch T, Hesse A (2003) Reference range for gastrointestinal oxalate absorption measured with a standardized [13C2]oxalate absorption test. J Urol 169:687–690
    Article Google Scholar
  10. Schwartz GJ, Munoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20:629–637
    Article PubMed PubMed Central Google Scholar
  11. Levey AS, Coresh J, Greene T, Marsh J, Stevens LA, Kusek JW, van Lente F (2007) Expressing the modification of diet in renal disease study equation for estimating glomerular filtration rate with standardized serum creatinine values. Clin Chem 53:766–772
    Article PubMed CAS Google Scholar
  12. Gambaro G, Croppi E, Coe F, Lingeman J, Moe O, Worcester E, Buchholz N, Bushinsky D, Curhan GC, Ferraro PM, Fuster D, Goldfarb DS, Heilberg IP, Hess B, Lieske J, Marangella M, Milliner D, Preminger GM, Reis Santos JM, Sakhaee K, Sarica K, Siener R, Strazzullo P, Williams JC, The Consensus Conference Group (2016) Metabolic diagnosis and medical prevention of calcium nephrolithiasis and its systemic manifestations: a consensus statement. J Nephrol 29:715–734
    Article PubMed PubMed Central CAS Google Scholar
  13. Pak CYC, Poindexter JR, Peterson RD, Heller HJ (2004) Biochemical and physicochemical presentations of patients with brushite stones. J Urol 171:1046–1049
    Article PubMed Google Scholar
  14. Thamilselvan S, Khan SR (1998) Oxalate and calcium oxalate crystals are injurious to renal epithelial cells: results of in vivo and in vitro studies. J Nephrol 11:66–69
    PubMed Google Scholar
  15. Parks JH, Coe FL, Evan AP, Worcester EM (2009) Urine pH in renal calcium stone formers who do and do not increase stone phosphate content with time. Nephrol Dial Transplant 24:130–136
    Article PubMed CAS Google Scholar
  16. Backman U, Danielson BG, Johansson G, Ljunghall S, Wikström B (1980) Incidence and clinical importance of renal tubular defects in recurrent renal stone formers. Nephron 25:96–101
    Article PubMed CAS Google Scholar
  17. Leumann E, Hoppe B (2001) The primary hyperoxalurias. J Am Soc Nephrol 12:1986–1993
    PubMed CAS Google Scholar
  18. Holmes RP, Goodman HO, Assimos DG (2001) Contribution of dietary oxalate to urinary oxalate excretion. Kidney Int 59:270–276
    Article PubMed CAS Google Scholar
  19. Hönow R, Hesse A (2002) Comparison of extraction methods for the determination of soluble and total oxalate in foods by HPLC-enzyme-reactor. Food Chem 78:511–521
    Article Google Scholar
  20. Siener R, Hönow R, Seidler A, Voss S, Hesse A (2006) Oxalate contents of species of the Polygonaceae, Amaranthaceae and Chenopodiaceae families. Food Chem 98:220–224
    Article CAS Google Scholar
  21. Schroder T, Vanhanen L, Savage GP (2011) Oxalate content in commercially produced cocoa and dark chocolate. J Food Compos Anal 24:916–922
    Article CAS Google Scholar
  22. Hönow R, Gu KLR, Hesse A, Siener R (2010) Oxalate content of green tea of different origin, quality, preparation and time of harvest. Urol Res 38:377–381
    Article PubMed CAS Google Scholar
  23. Siener R, Seidler A, Voss S, Hesse A (2016) The oxalate content of fruit and vegetable juices, nectars and drinks. J Food Compos Anal 45:108–112
    Article CAS Google Scholar
  24. Siener R, Bade DJ, Hesse A, Hoppe B (2013) Dietary hyperoxaluria is not reduced by treatment with lactic acid bacteria. J Transl Med 11:306. https://doi.org/10.1186/1479-5876-11-306
    Article PubMed PubMed Central CAS Google Scholar
  25. Knight J, Holmes RP, Cramer SD, Takayama T, Salido E (2012) Hydroxyproline metabolism in mouse models of primary hyperoxaluria. Am J Physiol Renal Physiol 302:F688–F693
    Article PubMed CAS Google Scholar
  26. Knight J, Jiang J, Assimos DG, Holmes RP (2006) Hydroxyproline ingestion and urinary oxalate and glycolate excretion. Kidney Int 70:1929–1934
    Article PubMed PubMed Central CAS Google Scholar
  27. von Unruh GE, Voss S, Sauerbruch T, Hesse A (2004) Dependence of oxalate absorption on the daily calcium intake. J Am Soc Nephrol 15:1567–1573
    Article CAS Google Scholar

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Authors and Affiliations

  1. Department of Urology, University Stone Centre, University of Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany
    Roswitha Siener, Patricia Löhr, Stefan C. Müller & Stefan Latz
  2. Division of Pediatric Nephrology, Department of Pediatrics, University of Bonn, Bonn, Germany
    Bernd Hoppe

Authors

  1. Roswitha Siener
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  2. Bernd Hoppe
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  3. Patricia Löhr
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  4. Stefan C. Müller
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  5. Stefan Latz
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Correspondence toRoswitha Siener.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Siener, R., Hoppe, B., Löhr, P. et al. Metabolic profile and impact of diet in patients with primary hyperoxaluria.Int Urol Nephrol 50, 1583–1589 (2018). https://doi.org/10.1007/s11255-018-1939-1

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