CEPHALOSPORINS AS A POTENTIAL RISK FACTOR FOR UROLITHIASIS: A CASE-CONTROL STUDY
DOI:
https://doi.org/10.22159/ajpcr.2025v18i4.53944Keywords:
Cephalosporins, Gut microbiota, Kidney stones, Oxalobacter formigenes, Urinary oxalateAbstract
The study aimed to explore the impact of Oxalobacter formigenes colonization and cephalosporin antibiotic treatment on urinary oxalate, calcium, and citrate levels, with a focus on evaluating the bacterium’s role in mitigating the risk of calcium oxalate kidney stone formation. An observational, case-control study was conducted involving 350 control subjects and 280 kidney stone patients. Participants were stratified based on recent cephalosporin use and O. Formigenes colonization. Results demonstrated that O. Formigenes colonized individuals consistently exhibited lower urinary oxalate and calcium levels and higher citrate levels compared to non-colonized counterparts. Cephalosporin treatment exacerbated urinary biochemical imbalances, further increasing oxalate and calcium excretion while reducing citrate levels, particularly in non-colonized individuals. This highlights the protective role of O. Formigenes in maintaining urinary biochemical homeostasis and reducing kidney stone risk. The findings underscore the need for strategies to preserve gut microbiota, especially O. Formigenes, during antibiotic therapy to mitigate metabolic consequences and prevent urolithiasis.
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Naveen V, Siddiq A, Chandana G. A study on drug utilization pattern of cephalosporins in general medicine and surgical inpatient department. Int J Curr Pharm Res. 2018;10(3):33-6.
Joshi A, Khumbani U, Ganjiwale J, Ganguly B. Prescribing patterns of cephalosporin in children following implementation of antibiotic stewardship program in a tertiary care hospital at Western India. Asian J Pharm Clin Res. 2020;13(9):110-4.
Ivanovski O, Drüeke TB. A new era in the treatment of calcium oxalate stones? Kidney Int. 2013;83(6):998-1000.
Miller AW, Penniston KL, Fitzpatrick K, Agudelo J, Tasian G, Lange D. Mechanisms of the intestinal and urinary microbiome in kidney stone disease. Nat Rev Urol. 2022;19(12):695-707.
Sharma AP, Burton J, Filler G, Dave S. Current update and future directions on gut microbiome and nephrolithiasis. Indian J Urol. 2020;36(4):262-9.
Ticinesi A, Nouvenne A, Chiussi G, Castaldo G, Guerra A, Meschi T. Calcium oxalate nephrolithiasis and gut microbiota: Not just a gut-kidney axis. A nutritional perspective. Nutrients. 2020;12(2):548.
Nazzal L, Blaser MJ. Does the receipt of antibiotics for common infectious diseases predispose to kidney stones? A cautionary note for all health care practitioners. J Am Soc Nephrol. 2018;29(6):1590-2.
Sodimbaru V, Pujari L. Urolithiasis-an update review over genetics, pathophysiology and its clinical management. Int J Pharm Pharm Sci. 2014;6(11):24-31.
Ariceta G, Collard L, Abroug S, Moochhala SH, Gould E, Boussetta A, et al. ePHex: A phase 3, double-blind, placebo-controlled, randomized study to evaluate long-term efficacy and safety of Oxalobacter formigenes in patients with primary hyperoxaluria. Pediatr Nephrol. 2023;38(2):403-15.
Yang Y, Sharma PD, Nair V, Jhaveri KD, Malieckal DA, Wanchoo R, et al. Kidney oxalate crystal deposition in adult patients: A relatively common finding. Clin Nephrol. 2020;93(5):243-50.
Daudon M, Jungers P. Drug-induced renal stones. In: Urinary Tract Stone Disease. London: Springer; 2010. p. 225-37.
Ravikumar Y, Begum RF, Velmurugan R. Oxalobacter formigenes reduce the risk of kidney stones in patients exposed to oral antibiotics: A case-control study. Int Urol Nephrol. 2021;53(1):13-20.
Bostanghadiri N, Ziaeefar P, Sameni F, Mahmoudi M, Hashemi A, Darban-Sarokhalil D. The controversial association of gut and urinary microbiota with kidney stone formation. Microb Pathog. 2021;161:105257.
Joubran P, Roux FA, Serino M, Deschamps JY. Gut and urinary microbiota in cats with kidney stones. Microorganisms. 2024;12(6):1098.
Stanford J, Charlton K, Stefoska-Needham A, Ibrahim R, Lambert K. The gut microbiota profile of adults with kidney disease and kidney stones: A systematic review of the literature. BMC Nephrol. 2020;21(1):215.
Siener R, Bangen U, Sidhu H, Hönow R, Von Unruh G, Hesse A. The role of Oxalobacter formigenes colonization in calcium oxalate stone disease. Kidney Int. 2013;83:1144-9.
Tasian G, Miller A, Lange D. Antibiotics and kidney stones: Perturbation of the gut-kidney axis. Am J Kidney Dis. 2019;74(6):724-6.
Böhles H, Gebhardt B, Beeg T, Sewell AC, Solem E, Posselt G. Antibiotic treatment-induced tubular dysfunction as a risk factor for renal stone formation in cystic fibrosis. J Pediatr. 2002;140(1):103-9.
Asplin JR. Hyperoxaluric calcium nephrolithiasis. Endocrinol Metab Clin North Am. 2002;31(4):927-49.
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