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Pathophysiology and Treatment of Enteric Hyperoxaluria

Celeste Witting, Craig B. Langman, Dean Assimos, Michelle A. Baum, Annamaria Kausz, Dawn Milliner, Greg Tasian, Elaine Worcester, Meaghan Allain, Melissa West, Felix Knauf and John C. Lieske
CJASN March 2021, 16 (3) 487-495; DOI: https://doi.org/10.2215/CJN.08000520
Celeste Witting
1Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Craig B. Langman
1Feinberg School of Medicine, Northwestern University, Chicago, Illinois
2Division of Kidney Diseases, Lurie Children’s Hospital of Chicago, Chicago, Illinois
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Dean Assimos
3Department of Urology, University of Alabama-Birmingham, Birmingham, Alabama
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Michelle A. Baum
4Division of Nephrology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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Annamaria Kausz
5Allena Pharmaceuticals, Inc., Newton, Massachusetts
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Dawn Milliner
6Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
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Greg Tasian
7Department of Surgery, Division of Urology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Elaine Worcester
8Department of Medicine, University of Chicago, Chicago, Illinois
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Meaghan Allain
9American Society of Nephrology, Washington, DC
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Melissa West
9American Society of Nephrology, Washington, DC
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Felix Knauf
10Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
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John C. Lieske
5Allena Pharmaceuticals, Inc., Newton, Massachusetts
11Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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Abstract

Enteric hyperoxaluria is a distinct entity that can occur as a result of a diverse set of gastrointestinal disorders that promote fat malabsorption. This, in turn, leads to excess absorption of dietary oxalate and increased urinary oxalate excretion. Hyperoxaluria increases the risk of kidney stones and, in more severe cases, CKD and even kidney failure. The prevalence of enteric hyperoxaluria has increased over recent decades, largely because of the increased use of malabsorptive bariatric surgical procedures for medically complicated obesity. This systematic review of enteric hyperoxaluria was completed as part of a Kidney Health Initiative–sponsored project to describe enteric hyperoxaluria pathophysiology, causes, outcomes, and therapies. Current therapeutic options are limited to correcting the underlying gastrointestinal disorder, intensive dietary modifications, and use of calcium salts to bind oxalate in the gut. Evidence for the effect of these treatments on clinically significant outcomes, including kidney stone events or CKD, is currently lacking. Thus, further research is needed to better define the precise factors that influence risk of adverse outcomes, the long-term efficacy of available treatment strategies, and to develop new therapeutic approaches.

  • chronic kidney disease
  • hyperoxaluria
  • fat malabsorption
  • nephrolithiasis
  • Copyright © 2021 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 16 (3)
Clinical Journal of the American Society of Nephrology
Vol. 16, Issue 3
March 08, 2021
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Pathophysiology and Treatment of Enteric Hyperoxaluria
Celeste Witting, Craig B. Langman, Dean Assimos, Michelle A. Baum, Annamaria Kausz, Dawn Milliner, Greg Tasian, Elaine Worcester, Meaghan Allain, Melissa West, Felix Knauf, John C. Lieske
CJASN Mar 2021, 16 (3) 487-495; DOI: 10.2215/CJN.08000520

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Pathophysiology and Treatment of Enteric Hyperoxaluria
Celeste Witting, Craig B. Langman, Dean Assimos, Michelle A. Baum, Annamaria Kausz, Dawn Milliner, Greg Tasian, Elaine Worcester, Meaghan Allain, Melissa West, Felix Knauf, John C. Lieske
CJASN Mar 2021, 16 (3) 487-495; DOI: 10.2215/CJN.08000520
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  • Article
    • Abstract
    • Introduction
    • Pathophysiology of Enteric Hyperoxaluria
    • Causes of Enteric Hyperoxaluria
    • Prevalence of Enteric Hyperoxaluria in the United States
    • Nephrolithiasis in Enteric Hyperoxaluria
    • Other Kidney Complications and Natural History
    • Current Therapies
    • Future Directions and Knowledge Gaps
    • Conclusion
    • Disclosures
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    • Acknowledgments
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    • References
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More in this TOC Section

  • Klotho in Clinical Nephrology
  • Decision Algorithm for Prescribing SGLT2 Inhibitors and GLP-1 Receptor Agonists for Diabetic Kidney Disease
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Keywords

  • chronic kidney disease
  • hyperoxaluria
  • fat malabsorption
  • nephrolithiasis

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