Hyperoxaluria in Inflammatory Bowel Diseases

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Questions and Answers

What is a common consequence of fat malabsorption in patients with inflammatory bowel diseases or gastric bypass?

Increased calcium absorption

Increased absorption of oxalate (correct)

Decreased colonic permeability to oxalate

Increased reabsorption of bile acids

What is the effect of unabsorbed fatty acids on calcium in the gut?

Increase calcium absorption

Increase calcium availability in a soluble form

Decrease calcium availability in a soluble form (correct)

No effect on calcium availability

What percentage of urinary oxalate comes from ascorbic acid?

50-70%

80-90%

10-20%

35-55% (correct)

What is the effect of a high protein diet on oxalate synthesis?

No effect on oxalate synthesis Signup and view all the answers

What is the role of pyridoxine in oxalate synthesis?

Acts as a cofactor in glyoxylate to glycine conversion Signup and view all the answers

What is the effect of Oxalobacter formigenes colonization on urinary oxalate excretion?

Decrease urinary oxalate excretion Signup and view all the answers

What is a dietary advice for reducing urinary oxalate?

Use of Oxalobacter formigenes probiotic Signup and view all the answers

What is a potential consequence of excessive vitamin C intake in CKD patients?

Stone formation Signup and view all the answers

What is one of the common nutrition diagnoses in the CKD population?

Inadequate mineral intake Signup and view all the answers

What is the recommended percentage of protein that should come from high biologic value sources?

50% to 60% Signup and view all the answers

What is the recommended protein intake for patients with GFR greater than 55 mL/min?

0.8 g/kg/day Signup and view all the answers

What is the recommended energy intake for adults with CKD?

35 kcal/kg/day Signup and view all the answers

What is the recommended protein intake for patients with GFR less than 25 mL/min who have not yet begun dialysis?

0.6 g/kg/day Signup and view all the answers

What is the recommended protein intake for nondialysis patients with AKI?

0.5-0.8 g/kg Signup and view all the answers

Why is controlling systemic hypertension important in CKD patients?

To reduce the progressive loss of renal function Signup and view all the answers

What is the benefit of protein restriction in CKD patients?

To produce benefits from protein restriction Signup and view all the answers

What happens to protein needs during CRRT?

They increase to 1.5-2.5 g/kg Signup and view all the answers

What is the recommended increase in protein intake if patients cannot maintain an adequate caloric intake?

0.75 g/kg/day Signup and view all the answers

What is the minimum protein intake recommended during the stable period before renal function returns?

0.8-1 g/kg Signup and view all the answers

Why should calorie needs be estimated at 25 to 40 cal/kg of upper end IBW or adjusted IBW per day?

To prevent excess CO2 production Signup and view all the answers

What is the purpose of high-calorie, low-protein formulas in AKI patients?

To prevent the use of protein for energy production Signup and view all the answers

Why is meticulous attention to fluid status essential during the early phase of AKI?

To balance fluid and electrolyte intake with net output Signup and view all the answers

What contributes to total body water output in AKI patients with negligible urine output?

Emesis, diarrhea, body cavity drains, and skin and respiratory losses Signup and view all the answers

Why is care necessary when using high-calorie, low-protein formulas in AKI patients?

To monitor for hyperglycemia Signup and view all the answers

What is a potential consequence of severely limiting sodium intake or using diuretics constantly in patients with hypalbuminemia?

Marked hypotension Signup and view all the answers

Why may patients with early stage CKD require potassium supplementation?

Due to use of potassium-wasting diuretics Signup and view all the answers

At what eGFR level should patients be evaluated for renal bone disease?

Less than 60 Signup and view all the answers

What is the daily phosphorus intake recommended for patients with CKD?

Less than 1000 mg Signup and view all the answers

What is a consequence of dyslipidemia in CKD patients?

Cardiovascular disease Signup and view all the answers

Why may CKD patients benefit from a water-soluble renal customized vitamin supplement?

Due to restrictions in diet Signup and view all the answers

What is a function of the glomerulus that is important with respect to disease?

Production of ultrafiltrate and prevention of certain substances from entering it Signup and view all the answers

What is the recommended daily sodium intake for controlling edema in patients with hypoalbuminemia?

Less than 1500 mg Signup and view all the answers

What is the primary goal of nutrition management for patients with renal disease?

To prevent deficiency and maintain good nutrition status Signup and view all the answers

What is the recommended daily protein intake for patients receiving HD three times per week?

1.2 g/kg of body weight Signup and view all the answers

Why is prealbumin not a good nutritional marker in renal failure?

Because values are routinely elevated Signup and view all the answers

What is the significance of serum albumin levels in patients with ESRD?

It is a predictor of poor survival Signup and view all the answers

Why is it essential to monitor serum BUN and serum Cr levels in patients on dialysis?

To adjust the diet accordingly Signup and view all the answers

What is the recommended protein intake for patients receiving PD?

1.2 to 1.5 g/kg of body weight Signup and view all the answers

What is the significance of HBV protein in patients with renal disease?

At least 50% of daily protein intake should be HBV protein Signup and view all the answers

What is the role of nutrition education in patients with renal disease?

To provide periodic counseling and long-term monitoring Signup and view all the answers

Study Notes

Inflammatory Bowel Diseases and Gastric Bypass

Patients with inflammatory bowel diseases or gastric bypass often develop hyperoxaluria due to fat malabsorption.
Malabsorption leads to failure to reabsorb bile acids and fatty acids, increasing colonic permeability to oxalate and increasing absorption of oxalate.
Unabsorbed fatty acids bind calcium, decreasing its availability to bind oxalate in the gut and prevent its absorption, leading to increased serum oxalate and urinary oxalate levels.

Oxalate Synthesis and Absorption

Urinary oxalate also comes from endogenous synthesis, proportional to lean body mass.
Ascorbic acid and glyoxylic acid account for a significant percentage of urinary oxalate.
In patients with CKD, excessive vitamin C intake may lead to stone formation.
Oxalate synthesis is not increased with a high protein diet.
Pyridoxine deficiency can increase endogenous oxalate production.
The bioavailability of food oxalate and urine oxalate are affected by salt forms of oxalate, food processing and cooking methods, meal composition, and the presence of Oxalobacter formigenes (OF) in the GI tract.

Oxalobacter formigenes and Stone Formation

Stone-forming patients who lack OF have significantly higher urinary oxalate excretion and stone episodes compared to patients colonized with the bacteria.
There is a 70% risk reduction in calcium-oxalate stone formers when there is OF colonization of their stool.
Administration of Oxalobacter formigenes as enteric-coated capsules significantly reduces urine oxalate in patients with primary hyperoxaluria.

Dietary Advice for Reducing Urinary Oxalate

Use of Oxalobacter formigenes as a probiotic.
Reduction of dietary oxalate.
Consumption of calcium-rich food or supplement to reduce oxalate absorption.
In CKD patients, excessive intake of vitamin C may lead to stone formation.

Uric Acid Stones and Protein Intake

The amount of protein recommended is influenced by the underlying cause of AKI and the presence of other conditions.
A range of recommended protein levels can be found in the literature, from 0.5-0.8 g/kg for non-dialysis patients to 1-2 g/kg for dialyzed patients.

Energy and Calorie Intake

Energy intake should be approximately 25-40 cal/kg of upper end IBW or adjusted IBW per day.
Excessive calorie intake can lead to excess CO2 production, depressing respiration.
Large intakes of carbohydrate and fat are needed to prevent the use of protein for energy production.

Fluid and Sodium Intake

During the early (often oliguric) phase of AKI, meticulous attention to fluid status is essential.
Ideally, fluid and electrolyte intake should balance the net output.
In CKD patients, control of edema is recommended with dietary intake of 1500 mg of sodium daily.

Potassium, Phosphorus, and Lipids

Many patients in early stage CKD take potassium-wasting diuretics and require supplementation.
When urine output drops below 1 L/day, patients may require a potassium restriction.
Serum phosphorous levels elevate at the same rate as eGFR decreases.
Early initiation of phosphate reduction therapies is advantageous for delaying hyperparathyroidism and bone disease.
Patients with an eGFR of less than 60 should be evaluated for renal bone disease and benefit from phosphorus restriction.

Vitamins and Minerals

CKD patients are routinely recommended a water-soluble renal customized vitamin supplement.
The diet is typically modified to allow no more than 1000 mg of phosphates daily.
Lowering protein intake in adult patients may also lower fat and cholesterol intake from animal sources.

Glomerular Diseases and Nutrition

The functions of the glomerulus that are important with respect to disease are production of an adequate ultrafiltrate and prevention of certain substances from entering this ultrafiltrate.
Prevent deficiency and maintain good nutrition status through adequate protein, energy, vitamin, and mineral intake.
Control edema and electrolyte imbalance by controlling sodium, potassium, and fluid intake.
Prevent or retard the development of renal osteodystrophy by controlling calcium, phosphorus, vitamin D, and PTH.

Nutrition Management

Coordinate patient care with families, dietitians, nurses, and physicians in acute care, outpatient, or skilled nursing facilities.
Provide initial nutrition education, periodic counseling, and long-term monitoring of patients.
Emphasize adequate protein intake in patients on dialysis, especially those with low albumin levels.
Monitor serum BUN and serum Cr levels, uremic symptoms, and weight, and adjust the diet accordingly.

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Description

This quiz explores the relationship between inflammatory bowel diseases and hyperoxaluria, including the impact of fat malabsorption and calcium availability on oxalate absorption.