The Use of Antibiotics and Risk of Kidney Stones

Shivam Joshi; David S. Goldfarb

Disclosures

Curr Opin Nephrol Hypertens. 2019;28(4):311-315. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: The effect of the intestinal microbiome on urine chemistry and lithogenicity has been a popular topic. Here we review the evidence for exposure to antibiotics increasing the risk of nephrolithiasis.

Recent findings: Studies of the intestinal microbiome have focused on Oxalobacter formigenes, an anaerobe that frequently colonizes the human colon. As a degrader of fecal oxalate its presence is associated with lower urinary oxalate, which would be protective against calcium oxalate stone formation. It also appears capable of stimulating colonic oxalate secretion. A recent study showed that antibiotics can eliminate colonization with O. formigenes. In a case–control study, exposure to sulfa drugs, cephalosporins, fluoroquinolones, nitrofurantoin/methenamine, and broad spectrum penicillins prospectively increased the odds of nephrolithiasis. The effect was greatest for those exposed at younger ages and 3–6 months before being diagnosed with nephrolithiasis.

Summary: Recent evidence suggests a possible, causal role of antibiotics in the development of kidney stones. A possible explanation for this finding includes alterations in the microbiome, especially effects on oxalate-degrading bacteria like O. formigenes. Ample reasons to encourage antibiotic stewardship already exist, but the possible role of antibiotic exposure in contributing to the increasing prevalence of kidney stones in children and adults is another rationale.

Introduction

Nephrolithiasis is a complex disorder with multiple contributing factors, including environmental, lifestyle, and genetic causes. The prevalence of nephrolithiasis has increased by 70% over the last three decades.[1] Changes in diet, increasing prevalence of overweight and metabolic syndrome, and diabetes are often considered likely to be causative in this observed increase.[2] Although these and other variables are likely to be important, we have posited that increasing use of antibiotics is also a contributing factor in the development of nephrolithiasis. The role of antibiotics could arise from alterations in the intestinal microbiome of people who receive them for a variety of infectious diseases. The role of the intestinal microbiome as an influence on urine chemistry and lithogenicity has long been a topic of interesting speculation. Recent observational evidence has more convincingly linked oral antibiotic exposure to the development of kidney stones. In this article, we review the evidence for exposure to antibiotics increasing the risk of nephrolithiasis and possibly having a causal role.

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