Enteric hyperoxaluria - mechanism (fat malabsorption and calcium-oxalate binding)
Core concept
- Enteric hyperoxaluria = excess urinary oxalate excretion driven by fat malabsorption with an intact colon
- Normally, dietary calcium binds oxalate in the gut lumen -> forms insoluble calcium oxalate -> excreted in stool, minimal free oxalate absorbed
- Fat malabsorption -> unabsorbed fatty acids preferentially bind luminal calcium (saponification) -> calcium no longer available to bind oxalate -> free oxalate remains soluble -> absorbed by the colon (made permeable/more absorptive by bile acids) -> hyperoxaluria -> calcium oxalate renal stones
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