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.