Grocholski Christophe, Chambrier Cécile, Lauverjat Madeleine, Acquaviva Cécile, Abid Nadia, Bergoin Charlotte, Guebre-Egziabher Fitsum, Bacchetta Justine, Derain-Dubourg Laurence, De Mul Aurélie, Lemoine Sandrine
Nephrology, Dialysis, Hypertension and Functional Renal Explorations, Hôpital Edouard Herriot, Hospices Civils de Lyon, France.
Intensive Clinical Nutrition Unit, Accredited Centre for Home Parenteral Nutrition, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France.
Kidney Int Rep. 2023 Dec 28;9(3):686-693. doi: 10.1016/j.ekir.2023.12.023. eCollection 2024 Mar.
Patients with short bowel syndrome (SBS) may exhibit enteric hyperoxaluria (EH), and the prevalence of oxalate nephropathy in SBS is likely underestimated. Plasma oxalate (POx) is a surrogate of systemic oxalate deposition and, consequently, may increase the risk of developing chronic kidney disease (CKD). The main objective of this study was to explore the distribution of POx levels in patients with SBS.
Patients followed for SBS were recruited prospectively in the OXAGO study (NCT04119765) to assess POx during their annual renal follow-up including iohexol clearance. The inclusion criteria were age ≥18 years, and SBS type 2 and type 3 for more than 6 months.
A total of 47 patients were included but only 45 patients has a measured POx (55% males, 80% SBS type 2, 66% parenteral nutrition, 61% kidney stone history). POx levels were 6.8 ± 4.4 μmol/l, 29% of patients had POx ≥5 μmol/l. In the whole cohort, mean urinary oxalate (UOx) was 648±415 and 54% were >500 μmol/24h. In the group of patients with high POx levels (HPO), 24-hour urine oxalate was significantly higher than in the group with normal POx levels (NPO) (919 ± 566 vs. 526 ± 257 μmol/l; = 0.003). Glomerular filtration rate (GFR) was 66 ± 22 ml/min per 1.73 m, and 91% had CKD. GFR was significantly lower in the HPO than in the NPO group (49 ± 23 vs. 73 ± 18 ml/min per 1.73 m; = 0.0005.
Patients with SBS can display increased POx levels even with GFR >30 ml/min per 1.73 m. POx may be an interesting biomarker to assess the severity of EH.
短肠综合征（SBS）患者可能会出现肠道高草酸尿症（EH），SBS中草酸盐肾病的患病率可能被低估。血浆草酸盐（POx）是全身草酸盐沉积的替代指标，因此可能会增加患慢性肾脏病（CKD）的风险。本研究的主要目的是探讨SBS患者中POx水平的分布情况。
在OXAGO研究（NCT04119765）中前瞻性招募随访的SBS患者，在其年度肾脏随访期间评估POx，包括碘海醇清除率。纳入标准为年龄≥18岁，2型和3型SBS病程超过6个月。
共纳入47例患者，但仅45例患者测量了POx（55%为男性，80%为2型SBS，66%接受肠外营养，61%有肾结石病史）。POx水平为6.8±4.4μmol/l，29%的患者POx≥5μmol/l。在整个队列中，平均尿草酸（UOx）为648±415，54%的患者>500μmol/24小时。在高POx水平（HPO）组中，24小时尿草酸显著高于正常POx水平（NPO）组（919±566 vs.526±257μmol/l；P = 0.003）。肾小球滤过率（GFR）为66±22 ml/min/1.73 m²，91%的患者患有CKD。HPO组的GFR显著低于NPO组（49±23 vs.73±18 ml/min/1.73 m²；P = 0.0005）。
即使GFR>30 ml/min/1.73 m²，SBS患者的POx水平也可能升高。POx可能是评估EH严重程度的一个有意义的生物标志物。
