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Common Gut Bacterium May Reduce Risk of Kidney Stones 3-5-08
BOSTON, March 5 -- Presence of Oxalobacter formigenes in the intestinal tract is associated with a 70% decreased likelihood of developing calcium oxalate kidney stones, a case-control study revealed.
The bacteria were more prevalent in healthy controls than in patients with a
history of calcium oxalate stones (38% versus 17%), David Kaufman, Sc.D., of
Boston University, and colleagues reported in the March issue of the Journal of
the American Society of Nephrology.
That equates to an odds ratio of 0.3 (95% CI 0.2 to 0.5) for developing calcium
oxalate stones after controlling for demographic factors, dietary oxalate,
antibiotic use, and family history of stones. Up to 80% of kidney stones are
made up primarily of calcium oxalate.
These findings may have clinical applications, according to the investigators.
"The possibility of using the bacterium as a probiotic is in the early stages of
investigation," they said.
Reducing the intake of foods high in oxalate has been proposed as a way to
prevent formation of stones but whether this works remains uncertain, the
investigators said.
A microbiological approach focusing on O. formigenes, a Gram-negative anaerobic
bacterium found in the gut that has no known side effects, has received
consideration in recent years, they said.
Reported prevalence of the bacterium ranges from 46% to 77%.
The bacterium consumes oxalate, and its absence could result in "higher oxalate
excretion in the urine and thus predisposition to [calcium oxalate] calculus
formation," they said.
To evaluate the association between O. formigenes and stone formation, Dr.
Kaufman and colleagues recruited 247 patients with a recurrent episode of
calcium oxalate nephrolithiasis and 259 healthy controls from three Boston
hospitals and the Duke Medical Center.
The two groups were similar in age (median 48), gender (62% male), and region
(75% from Boston).
Stool samples were tested for presence of the bacterium.
All participants completed a food frequency questionnaire that was used to
measure oxalate consumption.
Among the healthy controls, prevalence of O. formigenes was lowest (29%) in
those who took antibiotics to which the bacterium is sensitive -- for example,
macrolides, tetracyclines, chloramphenicol, rifampin, or metronidazole -- at any
time in the past. Prevalence was highest (59%) in controls who had never used
these antibiotics or taken any others in the past five years -- the non-users.
Among the case patients, the corresponding prevalences were 14% for those who
had taken one of the O. formigenes-sensitive antibiotics and 33% in non-users.
"However, the association between the bacterium and kidney stones did not seem
to be materially affected by antibiotic use," the researchers said.
A subset of participants, 139 case patients and 138 controls, completed 24-hour
urine collections. The odds ratio for developing kidney stones increased
significantly with rising levels of urinary oxalate (P=0.002 for trend).
"Surprisingly," Dr. Kaufman and colleagues said, "median urinary oxalate
excretion did not differ with the presence or absence of O. formigenes
colonization." The median oxalate excretion for case patients positive for the
bacteria was 32 mg; it was 35 mg for those who did not have the bacteria. For
controls, the median values were 28 and 27 mg, respectively.
"The relation between O. formigenes status and urinary oxalate excretion
requires further investigation; pending that clarification, the lack of a clear
connection in this study should be considered a limitation," the researchers
said.
Of methodological concern, they said, is the fact that they measured the
presence of the bacterium by growing cultures on a medium selective for O.
formigenes with detection using a precipitation assay. Most previous studies
used PCR.
Also, this study was not able to determine when patients who developed kidney
stones were colonized with the bacteria.
"In addition to more trials focusing on its potential as a treatment," they
concluded, "further information is needed on the natural history of the
bacterium in human populations, factors governing persistent colonization
(particularly antibiotic sensitivity), and the bacterium's relation to first
stone episodes and urinary oxalate."
Comment: This is why it is always a good reason to supplement daily with Bella Mira Perfect Defense.