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Risk factors for developing hyperoxaluria in children with Crohn's disease
Amr Salem1, Happy Sawires2, Ayman Eskander3
1Pediatric Nephrology Department, Cairo University, Cairo, Egypt.
Insights
Lack of Oxalobacter formigenes colonization, steatorrhea, and frequent stools are key risk factors for enteric hyperoxaluria in pediatric Crohn's disease (CD) patients. Understanding these factors is crucial for effective disease management.
Area of Science:
- Pediatric Gastroenterology
- Nephrology
- Microbiome Research
Background:
- Enteric hyperoxaluria is a potential complication in pediatric Crohn's disease (CD).
- Understanding its occurrence and risk factors in this population is crucial for management.
Purpose of the Study:
- To investigate the prevalence and identify risk factors for enteric hyperoxaluria in children and adolescents with CD.
Main Methods:
- A cross-sectional study involving 45 pediatric CD patients and 45 controls.
- Analysis of spot urine ratios (calcium/creatinine, oxalate/creatinine, citrate/creatinine) and fecal Oxalobacter formigenes detection via PCR.
- Classification of patients into hyperoxaluric and normal urine oxalate excretion groups.
Main Results:
- Oxalobacter formigenes was absent in 91% of hyperoxaluric patients versus present in all controls (p < 0.001).
- Logistic regression identified lack of O. formigenes, steatorrhea, and frequent stools as significant risk factors (p < 0.001).
- No significant difference in urine oxalate/creatinine ratios was observed based on disease activity index.
Conclusions:
- Absence of intestinal O. formigenes, steatorrhea, and frequent stools are primary risk factors for enteric hyperoxaluria in pediatric CD.
- Identifying these risk factors aids in optimizing disease management strategies.
- Further research can leverage these findings for improved patient outcomes.
Background:
For the purpose of a better understanding of enteric hyperoxaluria in Crohn's disease (CD) in children and adolescents, we investigated the occurrence and risk factors for development of hyperoxaluria in those patients.
Methods:
Forty-five children with CD and another 45 controls were involved in this cross-sectional study. Urine samples were collected for measurement of spot urine calcium/creatinine (Ur Ca/Cr), oxalate/creatinine (Ur Ox/Cr), and citrate/creatinine (Ur Citr/Cr) ratios. Fecal samples were also collected to detect the oxalyl-CoA decarboxylase of Oxalobacter formigenes by PCR. Patients were classified into 2 groups: group A (with hyperoxaluria) and group B (with normal urine oxalate excretion). The disease extent was assessed, and the activity index was calculated.
Results:
According to the activity index, 30 patients (66.7%) had mild disease and 13 patients (28.9%) had moderate disease. There was no significant difference in Ur Ox/Cr ratio regarding the disease activity index. O. formigenes was not detected in 91% of patients in group A while it was detected in all patients in group B (p < 0.001). By using logistic regression analysis, the overall model was statistically significant when compared to the null model, (χ2 (7) = 52.19, p < 0.001), steatorrhea (p = 0.004), frequent stools (p = 0.009), and O. formigenes (p < 0.001).
Conclusion:
Lack of intestinal colonization with O. formigenes, steatorrhea, and frequent stools are the main risk factors for development of enteric hyperoxaluria in CD patients. Identifying risk factors facilitates proper disease management in future studies. A higher resolution version of the Graphical abstract is available as Supplementary information.
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