Do you recommend genetic testing to evaluate for primary hyperoxaluria in patients with recurrent calcium oxalate nephrolithiasis who have profound hyperoxaluria but also have a surgical history compatible with enteric hyperoxaluria?

Usually not. With that clear history, I wouldn’t think genotyping would have any yield. If the patient had a history of stones prior to the bariatric surgery, that might be different. As the price of genotyping declines, one could argue about this, especially if kidney transplantation is considered,...

In the scenario, you describe, I think genetic testing would be very reasonable.

Stephen B. Erickson, MD

It would clearly help guide therapy, particularly for PH1 given the availability of Lumasiran.

In a patient with enteric hyperoxaluria and previous surgery, I do not believe genetic testing is necessary. However, I do believe genetic testing is very helpful, and I try to get it for all patients who are agreeable to it.