Oxalic acid and the hyperoxaluric syndromes

Because calcium oxalate renal stones are the most common type of renal calculus found in this country, a discussion of oxalic acid and abnormalities associated with its synthesis and excretion seems warranted in a symposium of this sort. Although calcium metabolism and excretion have been investigated extensively in syndromes associated with recurrent nephrolithiasis, relatively little attention has been paid to oxalate in these conditions. Nevertheless, information now available, particularly concerning the known hyperoxaluric conditions, has led to greater understanding of idiopathic calcium oxalate nephrolithiasis and more rational treatment of this condition. In this review, the physicochemical and metabolic aspects of oxalic acid will be reviewed, followed by a discussion of the hyperoxaluric syndromes and the role of oxalate in idiopathic calcium oxalate stone disease.