Evaluation of postoperative nephrolithiasis and renal dysfunction in gastric cancer patients

Abstract

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.

Kidney Stone Risk Following Modern Bariatric Surgery

“…After full review of all existing literature in this area, we agree with the dietary recommendations that have been advocated by so many other authors: reduction in oxalate-rich and fatty foods to minimize enteric absorption, increased hydration to increase total urine volume, calcium supplementation using calcium citrate instead of calcium carbonate, and citric salts (potassium citrate) to correct metabolic acidosis and hypocitrituria [10, 16••, 17, 32]. Probiotics may also be beneficial, although existing data is limited [28].…”

“…Matlaga et al (2009) then reported claims data in a case–control study of 4,639 post-RYGB surgery patients compared to obese controls, demonstrating stone diagnosis in 7.65 % of RYGB versus 4.63 % of controls [16••]. To determine whether this phenomenon remained true in non-obese patients, Shimizu et al (2012) reviewed CTscans from gastric cancer patients who had either distal gastrectomy with Billroth I/Roux-en-Y or total gastrectomy with Roux-en-Y reconstruction [17]. In this population, patients with total gastrectomy were more likely to have renal stones by CT (21/85, 25 %) than patients with some portion of the stomach remaining (10/141, 7 %).…”

Kidney stone incidence and metabolic urinary changes after modern bariatric surgery: review of clinical studies, experimental models, and prevention strategies

“…Compared to restrictive procedures (such as the gastric band) which yield an estimated person-time stone incidence rate of 3.40 stones per 1000 person-years (25), Matlaga et al estimated person-time stone incidence rate of 16.62 stones per 1000 person-years for RYGB and 11.3 stones per 1000 person-years for routine obesity (22) . To see if this stone risk phenomenon remained true in non-obese patients, Shimizu et al (2012) reviewed CT scans from gastric cancer patients who had either distal gastrectomy with Bilroth I/Roux-en-Y versus total gastrectomy with Roux-en-Y reconstruction (23) . In this population, patients with total gastrectomy were more likely to have renal stones by CT diagnosis (21/85, i.e.…”

“…Additionally, bariatric stone formers should reduce daily fat intake to minimize enteric oxalate absorption and consider calcium supplementation using calcium citrate instead of calcium carbonate. Citrate salts, like potassium citrate, may be used to correct metabolic acidosis and hypocitraturia (10, 22, 23, 47) . As reviewed earlier, probiotics and pyridoxine supplementation may be beneficial, although data are limited (35) .…”

Kidney Stones After Bariatric Surgery: Risk Assessment and Mitigation

“…38,39 Likewise, the literature reports that citrate salts, such as potassium citrate, and alkali are able to play a role correcting hypocitraturia and metabolic acidosis. 15,28,32,40 Randomized controlled trials have demonstrated that potassium citrate is FIG. 2.…”