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Enteral feeding programs and hyperoxaluria: Is there a missing link?

  • Jonathan S. Ellison
    Correspondence
    Correspondence to: Jonathan S. Ellison, 999 N 92nd St, Suite 330, Milwaukee, WI 53226, USA, Tel.: +414-337-7316
    Affiliations
    Department of Urology, Medical College of Wisconsin & Children's Wisconsin, Milwaukee, WI, USA
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      Children with complex medical conditions pose many difficulties in the evaluation and prevention of their nephrolithiasis episodes. DeFoor et al. present the next logical step in understanding the etiology of urinary stone disease in these children. The authors investigated the 24-h urine analyses of children with complex chronic conditions, many of whom depend upon enteral nutrition, and compared these to an unmatched cohort of otherwise healthy children with nephrolithiasis. While such an analysis is limited due to the retrospective and uncontrolled nature of the assessments, the difficulty in obtaining urine samples in such a population makes this study a valuable manuscript for future reference. Interestingly, as opposed to common hypotheses related to calcium metabolism in the chronically immobilized, the authors found a significantly higher concentration of urinary oxalate in the study population. Several possibilities could exist to explain these differences. Oxalate is known to vary more substantially in younger populations and perhaps repeat 24-h studies would yield different results [
      • Ellison J.S.
      • Hollingsworth J.M.
      • Langman C.B.
      • Asplin J.R.
      • Schwaderer A.L.
      • Yan P.
      • et al.
      Analyte variations in consecutive 24-hour urine collections in children.
      ]. However, supposing these findings represent true and meaningful differences in urinary oxalate, a consideration of oxalate metabolism is warranted.
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