A Prospective Study of Risk Factors for Nephrolithiasis After Roux-en-Y Gastric Bypass Surgery

Park, Alyssa M.; Storm, Douglas W.; Fulmer, Brant R.; Still, Christopher D.; Wood, G. Craig; Hartle, James E.

doi:10.1016/j.juro.2009.07.044

Cited by 59 publications

(43 citation statements)

References 14 publications

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“…The prevalence rate of hyperoxaluria after BS (20%) in our study agrees closely with the rate reported by Duffey et al (8) (29%), but was lower than the rates reported by other studies, which reached values as high as 74% (5,(9)(10)(11)(12). On the other hand, the current mean oxalate excretion values were similar to those reported by other investigators (7,8,11). The highly variable degree of secondary hyperoxaluria may be due to differences in protein, lipid, calcium, and oxalate intake from other studies.…”

Section: Discussionsupporting

confidence: 90%

“…It may also have occurred because calcium supplements were withdrawn 3 days before urine collection in our study. Hypomagnesuria was not frequent in our series of post-BS patients, which was also the case in several other studies (5,7,(9)(10)(11)(12). This is most likely because magnesium depletion is more commonly due to diarrhea, which was detected in only two post-BS patients (one RYGB and one BD-DS).…”

Section: Discussionsupporting

confidence: 82%

“…The majority of post-BS patients presented low urinary volume as a predominant lithogenic factor, most likely related to low fluid intake due to a small gastric pouch, as also reported by others (7,8,11). The 24-hour urinary pH did not differ between groups.…”

Section: Discussionsupporting

confidence: 75%

“…Several recent studies demonstrated that urinary abnormalities, such as low urine volume, hypocitraturia, and more commonly, hyperoxaluria, may predispose bariatric patients to nephrolithiasis (4)(5)(6)(7)(8)(9)(10)(11)(12). Hyperoxaluria is the most frequent lithogenic factor detected in the majority of studies, with prevalence rates between 29% and 74% (4)(5)(6)(7)(8)(9)(10)(11)(12) and time to onset of 3-24 months after the procedure (8,9). The potential underlying mechanisms for hyperoxaluria have not yet been determined, but some degree of fat malabsorption is speculated to play a role through the binding of fatty acids to calcium, thereby inhibiting the formation of poorly soluble, nonabsorbable calcium oxalate in the intestinal lumen (11,13).…”

Section: Introductionmentioning

confidence: 99%

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Response to Dietary Oxalate after Bariatric Surgery

Froeder

Arasaki

Malheiros³

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Bariatric surgery (BS) may be associated with increased oxalate excretion and a higher risk of nephrolithiasis. This study aimed to investigate urinary abnormalities and responses to an acute oxalate load as an indirect assessment of the intestinal absorption of oxalate in this population.Design, setting, participants, & measurements Twenty-four-hour urine specimens were collected from 61 patients a median of 48 months after BS (post-BS) as well as from 30 morbidly obese (MO) participants; dietary information was obtained through 24-hour food recalls. An oral oxalate load test (OLT), consisting of 2-hour urine samples after overnight fasting and 2, 4, and 6 hours after consuming 375 mg of oxalate (spinach juice), was performed on 21 MO and 22 post-BS patients 12 months after BS. Ten post-BS patients also underwent OLT before surgery (pre-BS).Results There was a higher percentage of low urinary volume (,1.5 L/d) in post-BS versus MO (P,0.001). Hypocitraturia and hyperoxaluria (P=0.13 and P=0.36, respectively) were more frequent in BS versus MO patients. The OLT showed intragroup (P,0.001 for all periods versus baseline) and intergroup differences (P,0.001 for post-BS versus MO; P=0.03for post-BS versus pre-BS). The total mean increment in oxaluria after 6 hours of load, expressed as area under the curve, was higher in both post-BS versus MO and in post-BS versus pre-BS participants (P,0.001 for both).Conclusions The mean oxaluric response to an oxalate load is markedly elevated in post-bariatric surgery patients, suggesting that increased intestinal absorption of dietary oxalate is a predisposing mechanism for enteric hyperoxaluria.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 82%

Section: Discussionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

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Response to Dietary Oxalate after Bariatric Surgery

Froeder

Arasaki

Malheiros³

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…Some detailed analyses of the hyperoxaluria occurring after bariatric surgery have been performed by measuring urinary oxalate excretion in 24-h urine collections [9][10][11][12][13][14][15][16]. Duffey et al [10,11] conducted a long-term prospective study of the hyperoxaluria after R-Y gastric bypass, and revealed that the postoperative mean urinary oxalate excretion was significantly elevated from baseline at 3 months, and continued to grow in magnitude, reaching a stable level 1-2 years after surgery.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of postoperative nephrolithiasis and renal dysfunction in gastric cancer patients

et al. 2012

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Background Roux-en-Y (R-Y) gastric bypass, also known as bariatric surgery, sometimes causes postoperative hyperoxaluria and subsequent oxalate nephrolithiasis in obese patients. In this study, we retrospectively investigated the frequency of occurrence of nephrolithiasis and renal dysfunction in postoperative gastric cancer patients with respect to the surgical procedures employed. Methods Two hundred and twenty-six consecutive gastric cancer patients, who underwent distal gastrectomy with Billroth-I reconstruction (DGBI, 60 patients), distal gastrectomy with R-Y reconstruction (DGRY, 81 patients), and total gastrectomy with R-Y reconstruction (TGRY, 85 patients), were investigated for postoperative nephrolithiasis and renal dysfunction. We also examined the risk factors for postoperative nephrolithiasis in these patients with gastric cancer. Results Nephrolithiasis was detected in 3 (5 %), 7 (9 %), and 21 (25 %) patients in the DGBI, DGRY, and TGRY groups, respectively. There were significant differences in the frequency of nephrolithiasis between the DGBI and TGRY groups (p = 0.004), and between the DGRY and TGRY groups (p = 0.011), but there was no significant difference between the DGBI and DGRY groups. Multivariate logistic regression analysis revealed that gender and extent of gastrectomy were independent risk factors associated with nephrolithiasis. Renal dysfunction was found in 5 patients (6 %) in the TGRY group, but was not found in either the DGBI or the DGRY group. Nephrolithiasis was detected in all these 5 patients, and a renal biopsy performed in one patient revealed the presence of intratubular calcium oxalate crystals with chronic tubulointerstitial nephritis. Conclusion Total gastrectomy with R-Y reconstruction was an independent predictive factor for nephrolithiasis in patients with gastric cancer.

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Metabolic Management following Bariatric Surgery

Strohmayer

Via

Yanagisawa

2010

Mount Sinai J Medicine

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Bariatric surgery is an effective treatment option for obesity. Commonly utilized procedures are either restrictive, malabsorptive, or both. Substantial weight loss can be achieved. Postoperatively, patients experience nutritional, metabolic, and hormonal changes that have important clinical implications. The postoperative diet should be advanced carefully, according to protocol. Micronutrient deficiencies such as vitamin C, vitamin A, and zinc deficiencies are common, especially following malabsorptive procedures. Bone metabolism is greatly affected, in part due to vitamin D deficiency, decreased calcium absorption, and secondary hyperparathyroidism. Diabetes improves acutely in malabsorptive procedures and in sequence with weight loss in restrictive procedures. Polycystic ovarian syndrome improves in nearly all women with this condition who undergo bariatric surgery. Testosterone levels in men also improve after surgery. Consideration of these nutritional, metabolic, and hormonal changes allows for optimal medical management following bariatric surgery.

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A Prospective Study of Risk Factors for Nephrolithiasis After Roux-en-Y Gastric Bypass Surgery

Abstract: Our prospective study demonstrated multiple factors that increase the relative risk of nephrolithiasis after Roux-en-Y gastric bypass. These changes may make stone formation after Roux-en-Y gastric bypass increasingly likely and pose an ongoing challenge in the realm of urology.

Cited by 59 publications

References 14 publications

Response to Dietary Oxalate after Bariatric Surgery

Response to Dietary Oxalate after Bariatric Surgery

Evaluation of postoperative nephrolithiasis and renal dysfunction in gastric cancer patients

Metabolic Management following Bariatric Surgery

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