Recent advances in the pathophysiology of nephrolithiasis

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Abstract

Over the past 10 years, major progress has been made in the pathogenesis of uric acid and calcium stones. These advances have led to our further understanding of a pathogenetic link between uric acid nephrolithiasis and the metabolic syndrome, the role of Oxalobacter formigenes in calcium oxalate stone formation, oxalate transport in Slc26a6-null mice, the potential pathogenetic role of Randall's plaque as a precursor for calcium oxalate nephrolithiasis, and the role of renal tubular crystal retention. With these advances, we may target the development of novel drugs including (1) insulin sensitizers; (2) probiotic therapy with O. formigenes, recombinant enzymes, or engineered bacteria; (3) treatments that involve the upregulation of intestinal luminal oxalate secretion by increasing anion transporter activity (Slc26a6), luminally active nonabsorbed agents, or oxalate binders; and (4) drugs that prevent the formation of Randall's plaque and/or renal tubular crystal adhesions.

Original languageEnglish (US)
Pages (from-to)585-595
Number of pages11
JournalKidney international
Volume75
Issue number6
DOIs
StatePublished - 2009

Keywords

  • Calcium oxalate
  • Kidney stone
  • Metabolic syndrome
  • Nephrolithiasis
  • Uric acid

ASJC Scopus subject areas

  • Nephrology

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