Enteric Hyperoxaluria and Kidney Stone Management in Inflammatory Bowel Disease

Abstract

Enteric hyperoxaluria is frequently seen in patients with inflammatory bowel disease (IBD). IBD patients are therefore at higher risk of nephrolithiasis, particularly calcium oxalate stones. We reviewed the recent medical literature to elucidate the mechanisms and risk factors behind nephrolithiasis in IBD patients, as well as therapies to treat and prevent the formation of kidney stones. At present, there are no specific guidelines for screening and monitoring the progression of nephrolithiasis in the IBD population. Yet, recent epidemiologic data suggests that the prevalence of nephrolithiasis in the adult IBD patients is as high as 28%. Enteric oxalate levels of IBD patients are significantly elevated compared with non-IBD patients, and recent studies have shown that the gut microbiota largely mediates this process. In particular, intestinal disruption and malabsorption in IBD patients lead to the decolonization of Oxalobacter formigenes which normally metabolizes oxalate in the gut lumen. As such, future studies are needed to clarify the role of O. formigenes in IBD patients with the goal of devising new therapeutic approaches for nephrolithiasis treatment and risk reduction. Enteric hyperoxaluria plays a large role in nephrolithiasis, a serious extra-intestinal manifestation of IBD that may progress to chronic kidney disease. The gut microbiota offers a promising approach to treating and preventing hyperoxaluria in the IBD population.