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REVIEW ARTICLE
Year : 2020  |  Volume : 36  |  Issue : 4  |  Page : 262-269

Current update and future directions on gut microbiome and nephrolithiasis


1 Department of Pediatrics; Division of Nephrology, London Health Sciences Centre, Western University, London, Canada
2 Division of Urology, London Health Sciences Centre, Western University, London, Canada
3 Department of Pediatrics, London Health Sciences Centre, Western University, London, Canada

Correspondence Address:
Dr. Ajay P Sharma
Department of Pediatrics; Division of Nephrology, London Health Sciences Centre, Western University, London
Canada
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/iju.IJU_20_20

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The incidence of nephrolithiasis is increasing worldwide. Understanding how gut microbiome influences oxalate homeostasis has the potential to offer new strategies to prevent nephrolithiasis. The literature was reviewed to gather the evidence on the association between gut microbiome, hyperoxaluria and nephrolithiasis, and to identify the therapeutic interventions focused on the gut microbiome that could decrease hyperoxaluria and prevent nephrolithiasis. Gut microbiome is constituted by a plethora of microbiota including Oxalobacter formigenes (Oxf) and lactobacilli. Oxf can degrade dietary oxalate and induce enteral oxalate secretion. Animal studies suggested an association between oral Oxf supplementation and a decrease in hyperoxaluria. However, human studies have showed inconsistent results. Oral supplementation of lactobacilli did not show benefit in decreasing the hyperoxaluria. Antibiotic exposure, by affecting the gut microbiome, has been associated with an increase in nephrolithiasis. In vivo studies suggest fecal transplantation as a potential treatment option for reducing nephrolithiasis, but needs further evaluation in clinical studies. The current evidence suggests an association between gut microbiome and nephrolithiasis. However, the strategies focused on modulating gut microbiome for decreasing hyperoxaluria and preventing nephrolithiasis need further research. Judicious use of antibiotics in those predisposed to nephrolithiasis offers a preventative strategy for decreasing nephrolithiasis.


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