Evidence for abnormal linkage between urine oxalate and citrate excretion in human kidney stone formers

Background Animal models have demonstrated an interactive relationship between the epithelial anion exchanger SLC26A6 and transporter NaDC‐1 that regulates citrate and oxalate homeostasis. This relationship is a potential mechanism to protect against kidney stones as higher urine oxalate is accompanied by higher urine citrate but it has not been explored in humans. Methods We examined 24‐h urine data on 13,155 kidney stone forming patients (SF) from separate datasets at the University of Chicago and Litholink, a national laboratory, and 143 non‐kidney stone forming participants (NSF) to examine this relationship in humans. We used multivariate linear regression models to examine the association between oxalate and citrate in all study participants and separately in SF and NSF. Results Higher urinary oxalate was associated with higher urinary citrate in both SF and NSF. In NSF, the multivariate adjusted urine citrate excretion was 3.0 (1.5–4.6) (mmol)/creatinine (mmol) per oxalate (mmol)/creatinine (mmol). In SF, the multivariate adjusted urine citrate excretion was 0.3 (0.2–0.4) (mmol)/creatinine (mmol) per oxalate (mmol)/creatinine (mmol). Conclusions Higher urinary oxalate excretion was associated with higher urinary citrate excretion and this effect was larger in non‐kidney stone forming participants compared with those who form kidney stones. Adult male offspring of a rat model of polycystic ovary syndrome is born small compared to controls, and as adults have lower body weights, with higher cholesterol and proteinuria. Although the male PCOS offspring have similar blood pressure as controls, they have an exaggerated pressor response to angiotensin II. These data suggest that male offspring of PCOS women may develop cardiometabolic disease as adults or with aging.