Hypocitraturia and Hyperoxaluria After Roux-en-Y Gastric Bypass Surgery

Maalouf, Naim M.; Tondapu, Prasanthi; Guth, Eve; Livingston, Edward H.; Sakhaee, Khashayar

doi:10.1016/j.juro.2009.11.022

Cited by 70 publications

(45 citation statements)

References 31 publications

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“…Indeed, 47% of RYGB patients manifest hyperoxaluria compared to just 10.5% in obese controls, predisposing this population to the development of calcium oxalate type stones. 13 Calcium and vitamin D supplementation are routinely prescribed post-RYGB to prevent urolithiasis by decreasing oxalate absorption from the digestive tract. However, previous studies have shown that compliance with nutritional supplementation and vitamin D is only 33 and 27%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Long-term incidence of urolithiasis post-bariatric surgery

Haddad

Scheffler

Elkoushy

et al. 2014

CUAJ

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Introduction: The risk of urolithiasis post-Roux-en-Y gastric bypass (RYGB) surgery is higher when compared to the general population. Calcium and vitamin D supplementation is routinely prescribed to these patients, yet compliance with these supplements is unknown. The aim of this study was to assess the incidence of symptomatic de novo urolithiasis post-RYGB and compliance with calcium and vitamin D supplementation. Methods: A standardized telephone questionnaire was administered to patients who underwent RYGB between 1996 and 2011. Personal and medical histories were obtained with emphasis on episodes of symptomatic urolithiasis and calcium and vitamin D supplementation. Results: The response rate was 48% with 478 patients completing the telephone questionnaire. After a mean follow-up of 7.0 years (range: 1-15), the incidence of post-RYGB symptomatic urolithiasis was 7.3%, while the rate of de novo symptomatic urolithiasis was 5%. The overall median time to present with symptomatic urolithiasis was 3.1 years, with 3.3 years for de novo stone-formers, and 2.0 years for recurrent stone-formers (p = 0.38). In de novo stone-formers, 33% presented with symptomatic urolithiasis 4 to 14 years postoperatively. Compliance with calcium and vitamin D supplementation was 56% and 51%, respectively. Conclusions: Despite recall bias and lack of confirmatory imaging studies, a high postoperative incidence of symptomatic urolithiasis was found in a large sample of post-RYGB patients. A third of patients with de novo stones, presented with symptomatic urolithiasis 4 to 14 years postoperatively. Compliance with postoperative calcium and vitamin D supplementation was poor and needs improvement.

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Section: Discussionmentioning

confidence: 99%

Long-term incidence of urolithiasis post-bariatric surgery

Haddad

Scheffler

Elkoushy

et al. 2014

CUAJ

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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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“…However, recent data suggest that modern bariatric procedures, such as Roux-en-Y bypass, may also impart a twofold increased risk of nephrolithiasis, while 20-75% may have hyperoxaluria, including 20% with very high urine oxalate levels, also putting them at considerable risk of oxalate nephropathy (Table 2) (2,(5)(6)(7)(8)(9)(10)(11)(12). Purely restrictive bariatric procedures, such as gastric banding, may not increase oxalate excretion, yet more data are needed (Table 2) (13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

Enteric Oxalate Nephropathy in the Renal Allograft: An Underrecognized Complication of Bariatric Surgery

Troxell

Houghton

Hawkey³

et al. 2013

American Journal of Transplantation

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Enteric hyperoxalosis is a recognized complication of bariatric surgery, with consequent oxalate nephropathy leading to chronic kidney disease and occasionally end-stage renal failure. In patients with prior gastrointestinal bypass surgery, renal allografts are also at risk of oxalate nephropathy. Further, transplant recipients may be exposed to additional causes of hyperoxalosis. We report two cases of renal allograft oxalate nephropathy in patients with remote histories of bariatric surgery. Conservative management led to improvement of graft function in one patient, while the other patient returned to dialysis. Interpretation of serologic, urine and biopsy studies is complicated by oxalate accumulation in chronic renal failure, and heightened excretion in the early posttransplant period. A high index of suspicion and careful clinicopathologic correlation on the part of transplant nephrologists and renal pathologists are required to recognize and treat allograft oxalate nephropathy. As the incidence of obesity and pretransplant bariatric surgery increases in the transplant population, allograft oxalate nephropathy is likely to be an increasing cause of allograft dysfunction.

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Hypocitraturia and Hyperoxaluria After Roux-en-Y Gastric Bypass Surgery

Cited by 70 publications

References 31 publications

Long-term incidence of urolithiasis post-bariatric surgery

Long-term incidence of urolithiasis post-bariatric surgery

Evaluation of postoperative nephrolithiasis and renal dysfunction in gastric cancer patients

Enteric Oxalate Nephropathy in the Renal Allograft: An Underrecognized Complication of Bariatric Surgery

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