Nephropathy in dietary hyperoxaluria: A potentially preventable acute or chronic kidney disease

Table 1 Daily dietary oxalate intake in various countries and regions

Country-region	Subjects	Subject number	Oxalate intake (mg/24-h)	Ref.
Brazil, Sao Paolo	+Stones	70 (M:42, F:28)	98 ± 1373	[13]
	Healthy controls	41 (M:14, F:27)	108 ± 1333
England	Hospital diet	Not reported	118	[38]
Germany	+Stones, ↑oxaluria	93 (M:73, F:20)	130 ± 1813	[39]
	+Stones, →oxaluria	93 (M:73, F:20)	101 ± 1453
India, Rajasthan	Rural “common” diet	Not reported	78	[40]
	Rural rainy season	Not reported	2045
	Urban, upper income	Not reported	606
	Urban, lower income	Not reported	169
	Hospital diet	Not reported	139
India, Pune	Boys, upper income	100	193 (116-309)4	[41]
	Boys, lower income	100	169 (102-354)4
	Girls, upper income	100	168 (115-209)4
	Girls, lower income	100	133 (87-209)4
Italy	Normal subjects1	12 (M:8, F:4)	335	[42]
	Normal subjects2	12 (M:8, F:4)	18
United States, South	F, 50-79 yr, +Stones	1.179	330 ± 1613	[35]
	F, 50-79 yr. –Stones	1.179	345 ± 1663
United States	M, +Stones	1.627	214 ± 1173	[36]
	M, -Stones	44.358	214 ± 1213
	F, older, +Stones	1.414	184 ± 1093
	F, older, -Stones	91.358	185 ± 1123
	F, younger, +Stones	1.564	179 ± 1213
	F, younger, -Stones	100.260	183 ± 1213

¹Diet containing fruits and vegetables;

²Diet without fruits and vegetables;

³Mean ± SD;

⁴Mean (25^th-75^th percentile). +Stones: History of urinary stones; -Stones: Absence of history of urinary stones; M: Male; F: Female.

Table 2 Surgical procedures and medical conditions associated with enteric hyperoxaluria

Surgical conditions	Medical gastrointestinal conditions	Other medical/surgical conditions	Drugs
Jejunoileal bypass[106,108,110]	Crohn’s disease[109,119]	Morbid obesity[112]	Orlistat[130,131]
Roux-en-y gastric bypass[111,113]	Diabetic gastroenteropathy[115,116]	Cystic fibrosis[122,123]	Octreotide[132]
Small bowel resection[108,109]	Sprue[117]	Organ transplants[124-129]
Partial gastrectomy[108]	Primary biliary cirrhosis[109]
Pancreatectomy[109]	Chronic pancreatitis[118]
External biliary drainage[114]	Intestinal lymphangiectasia[120]
	Clostridium difficile colitis[121]

Table 3 Reports of parenchymal renal disease induced by dietary hyperoxaluria

Ref.	Daily oxalate intake (mg), duration	Urine oxalate (mg/24 per hour)	Peak SCr (mg/dL)	Clinical diagnosis, course, outcome, final SCr (mg/dL)
150	310, many mo	16.61	1.8	CKD with SCr 1.7-1.8
151	1880, 4 wk	34.22		AKI on diabetic CKD. Progression to ESRD
152	2240-2800, 6 mo	-	8.08	CKD. Progression to ESRD
153a	9000, 4 d	603	6.4	AKI, HDx10 days. SCr 0.9 in 6 wk
153b	4500, 5 d	-	9.3	AKI, HDx6 times. SCr 1.3 in 5 wk
153c	3600, NS	-	6	AKI, No HD. SCr 1.0 in 4 wk
153d	1800, NS	-	5.5	AKI, No HD. SCr 0.8 in 2 wk
153e	5400-6300, NS	-	12.3	AKI, HD. SCr 2.1 in 4 wk
153f	6300-7200, NS.	-	6.7	AKI, no HD. SCr 1.1 in 6 wk
153g	4500-5400, NS	-	9.8	AKI, HD. SCr 1.2 in 6 wk
153h	6300, NS	-	6.6	AKI, HD. SCr 1.1 in 4 wk
153i	2700-3600, NS	-	5.2	AKI, HD. SCr 0.8 in 2 wk
153j	7200 NS	-	10.4	AKI, HD. SCr 1.5 in 6 wk
154	1260, 6 wk	-	7.9	CKD on CKD from HTN. SCr 1.9 in 4 mo
155a	13120, once	74	12	AKI, HDx2 times. SCr 1.3 in 1 yr
155b	9240, once	74	11.7	AKI, no HD. SCr 1.3 in 4 mo
156	450-660, > 3 yr	-	6.9	CKD on other CKD, no HD. SCr 3.4 in 3 mo
157a	3725, once	-	-	AKI, no HD. Final SCr 1.1
157b	4360, once	-	6.3	AKI, no HD. Final SCr 1.1 NS
157c	7545, once	-	6.1	AKI, no HD. Final SCr 1.2
157d	1300, once	-	5.7	AKI, no HD. Final SCr 1.0
157e	2170, once	-	4.5	AKI, no HD. Final SCr 1.1
158	6830, once	-	16.4	AKI, no HD. SCr 0.9 mg/dL in 1 mo

¹During recovery. SCr approximately 1.7-1.8 mg/dL;

²Post-ingestion. SCr approximately 3.6 mg/dL;

³During AKI. SCr approximately 6.4 mg/dL;

⁴Post recovery. a,b,c,d,e,f,g,h,i,j,k in Ref. 153 and a,b,c,d,e in Ref. 157 represent the numerical sequence of the patients in these references (1^st, 2^nd, etc). SCr 1.3 mg/dL. SCr: Serum creatinine; AKI: Acute kidney injury; CKD: Chronic kidney disease; ESRD: End-stage renal disease; HD: Hemodialysis; NS: Not specified duration of intake.

Table 4 Daily urinary oxalate excretion in various hyperoxaluric states

Oxaluric state	Urinary oxalate, mg/24-h
Normal range	< 45, < 301
PH1	> 90[95], > 63[94], 25-492[90], 26-530[99]
PH2	> 42[95], 44-520[99]
PH3	80-194[98], 35-120[99]
Enteric	> 90[95], 30-110[1]1, 63 ± 13[2], 130[109], 52-92[118], 77 ± 44[123], 48-90[206]
Oral ascorbic acid	98[171], 37[172], 84[175]
Parenteral ascorbic acid	76[179], 100[180], 176[181], 88[182]
Ethylene glycol	29[190], 10[195]
Methoxyfluorane	96-480[205]
Idiopathic	< 63[95], 56 ± 15[39], 38-50[206], 48[207]
Dietary	< 54[95], 16.6[150], 34.2[151], 60[153]

Oxalate excretion is presented as a single number representing the mean or median of the study (not specified in several studies), range (interquartile range in reference 120), or mean ± SD. For patients with two or more sequential measurements of urinary oxalate excretion rate, the Table reports the highest oxalate excretion.

¹Pediatric values. PH1: Primary hyperoxaluria, type 1; PH2: Primary hyperoxaluria type 2; PH3: Primary hyperoxaluria type 3.