Steatorrhea and Hyperoxaluria in Severely Obese Patients Before and After Roux-en-Y Gastric Bypass

Moreland, Amber; Ana, Carol A. Santa; Asplin, John R.; Kuhn, Joseph A.; Holmes, Ross P.; Cole, Jason A.; Odstrcil, Elizabeth; Dinter, Thomas G. Van; Martı́nez, Juan Gabriel; Fordtran, John S.

doi:10.1053/j.gastro.2017.01.004

Cited by 34 publications

(22 citation statements)

References 47 publications

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“…50,55,56 In contrast, a recent study by Moreland, et al found no difference in mean urine oxalate levels in pre-versus post-RYGB patients (61 vs. 69 mg/day, p=0.92). 57 However, given that urine oxalate levels were very high both before and after surgery, high urine oxalate levels were still an important finding in that study and a contributor to kidney stone risk in those patients.…”

Section: Hyperoxaluriamentioning

confidence: 77%

“…31,39 Multiple studies have demonstrated that mean urine oxalate levels rise significantly after RYGB when pre-operative oxalate excretion was compared to post-operative oxalate excretion 6-12 months after surgery (Table 1). 39,[42][43][44][49][50][51][52][53][54][55][56][57] For example, in a study of 151 RYGB patients, Valezi et al found that urine oxalate increased from 24 mg/day pre-RYGB to 41 mg/day 12 months post-RYGB. 53 In addition, some, 56 but not all, 58 studies in which obese patients were compared to patients who had undergone RYGB showed higher urine oxalate in the operated patients.…”

Section: Hyperoxaluriamentioning

confidence: 99%

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Risk Factors for Kidney Stone Formation following Bariatric Surgery

Prochaska

Worcester

2020

Kidney360

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Kidney stones are painful, common, and increasing in incidence. Obesity and bariatric surgery rates are also on the rise in the United States. While bariatric surgery is associated with improvements in metabolic outcomes, malabsorptive bariatric surgery procedures are also associated with increased risk of kidney stones. Restrictive bariatric surgeries have not been associated with kidney stone risk. Higher risk of kidney stones after malabsorptive procedures is associated with post-surgical changes in urine composition, including high urine oxalate, low urine citrate, and low urine volume. Certain dietary recommendations after surgery may help mitigate these urine changes and reduce risk of kidney stones. Understanding risk of kidney stones after surgery is essential to improving patient outcomes after bariatric surgery.

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Section: Hyperoxaluriamentioning

confidence: 77%

Section: Hyperoxaluriamentioning

confidence: 99%

Risk Factors for Kidney Stone Formation following Bariatric Surgery

Prochaska

Worcester

2020

Kidney360

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“…Because the intestinal oxalate is not bound to calcium, oxalate is more readily absorbed in the small and large intestine rather than being excreted in the stool as in the normal physiologic state. 1,3,5,6 Increased serum oxalate levels can cause nephrotoxicity because most oxalate is excreted by the kidneys by glomerular filtration and proximal tubule secretion. 3 A minority of oxalate (5%-7%), as shown in a study utilizing a rat model, is excreted in the stool.…”

Section: Discussionmentioning

confidence: 99%

“…3 Much of this data is supported by a study that found that obese patients undergoing RYGB surgery have higher urinary oxalate excretion compared to nonobese individuals. 6 Patients with previous RYGB surgery also have an increased incidence of calcium oxalate nephrolithiasis and can have development of both acute and chronic kidney disease secondary to oxalosis. 11 In one study, RYGB patients were found to have approximately 70% greater chance of developing nephrolithiasis but, interestingly, did not have significantly increased risk of developing chronic kidney disease.…”

Section: Discussionmentioning

confidence: 99%

“…Unbound oxalate is more readily absorbed in the remaining small intestine and colon instead of excreted. 1,3,5,6 Post-RYGB renal diseases include calcium oxalate nephrolithiasis and oxalate nephropathy associated with interstitial oxalate deposits. 7 This patient developed oxalate nephropathy manifesting as acute kidney injury on a background of chronic kidney disease approximately 18 months after RYGB.…”

Section: Restriction Of Which One Of the Followingmentioning

confidence: 99%

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72-Year-Old Woman With Fatigue, Confusion, and Severe Acute Renal Failure

Zhang

Pawar

Greene

2018

Mayo Clinic Proceedings

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A 72-year-old woman presented to the hospital with confusion and fatigue accompanied by a 1-month history of declining renal function. Her medical history was notable for type 2 diabetes mellitus, hyperlipidemia, hypertension, obesity, a Roux-en-Y gastric bypass surgical procedure in 2015 (2 years before the current presentation), and a history of diffuse large B-cell lymphoma treated with splenectomy and chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). When seeing her primary care physician 2 weeks before the current admission, she had reported several weeks of progressive fatigue. During the primary care evaluation, results of routine complete blood cell count(s) and basic metabolic panel(s) were notable for a hemoglobin level of 10.8 g/dL, mean corpuscular volume of 94 fL, serum urea nitrogen level of 63 mg/dL, and serum creatinine concentration of 5.0 mg/dL (increased from a baseline of 1.6 mg/dL 6 months previously). Outpatient renal ultrasonography and a nephrology clinic consultation were scheduled, but the patient was seen in the emergency department because of acute confusion. Her family reported poor recall of recent events and forgetfulness during conversation. The review of systems was positive for night sweats, chills, and lower extremity edema. She did not have decreased urination, dysuria, hematuria, urinary urgency, increased urinary frequency, and/or urinary retention. At the time of admission, her medication list included acetaminophen, cyanocobalamin injection(s), gabapentin, oxycodone, simvastatin, multivitamin, and venlafaxine. She did not take over-the-counter medication(s) including nonsteroidal anti-inflammatory drugs, COX-2 inhibitors, and/or other supplements. She had no recent travel or illnesses.The patient's vital signs demonstrated normal temperature, heart rate of 78 beats/min, respiratory rate of 13 breaths/min, blood pressure of 147/66 mm Hg, and an oxygen saturation of 98% while breathing room air. Physical examination noted a nondistressed, elderly, white female. Skin examination revealed no petechiae or jaundice. She did not have palpable supraclavicular, infraclavicular, axillary, and/or inguinal lymphadenopathy. Her oral membranes were moist, and the skin turgor was normal. The cardiovascular and pulmonary examinations revealed normal jugular venous pressure(s), absence of murmurs, regular heart rate and rhythm, and clear breath sounds. She did not have costovertebral angle tenderness and/or abdominal bruits. At the time of admission, the patient was oriented to person, place, and time and was able to follow commands appropriately. Neurologic examination revealed intact cranial nerves II through XII without tremors or asterixis.Laboratory studies revealed the following (reference ranges provided parenthetically): hemoglobin, 9.6 g/dL (11.6-15.0 g/dL); mean corpuscular volume, 90 fL; leukocytes, 10.4 Â 10 9 /L; platelet count, 423 Â 10 9 /L; sodium, 134 mmol/L; potassium, 4.7 mmol/L; chloride, 98 mmol/L; bicarbonate, 16 mmol/L; serum urea ...

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New insights in the mechanisms of weight‐loss maintenance: Summary from a Pennington symposium

Flanagan,

Spann,

Berry

et al. 2023

Obesity

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Obesity is a chronic disease that affects more than 650 million adults worldwide. Obesity not only is a significant health concern on its own, but predisposes to cardiometabolic comorbidities, including coronary heart disease, dyslipidemia, hypertension, type 2 diabetes, and some cancers. Lifestyle interventions effectively promote weight loss of 5% to 10%, and pharmacological and surgical interventions even more, with some novel approved drugs inducing up to an average of 25% weight loss. Yet, maintaining weight loss over the long‐term remains extremely challenging, and subsequent weight gain is typical. The mechanisms underlying weight regain remain to be fully elucidated. The purpose of this Pennington Biomedical Scientific Symposium was to review and highlight the complex interplay between the physiological, behavioral, and environmental systems controlling energy intake and expenditure. Each of these contributions were further discussed in the context of weight‐loss maintenance, and systems‐level viewpoints were highlighted to interpret gaps in current approaches. The invited speakers built upon the science of obesity and weight loss to collectively propose future research directions that will aid in revealing the complicated mechanisms involved in the weight‐reduced state.

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Steatorrhea and Hyperoxaluria in Severely Obese Patients Before and After Roux-en-Y Gastric Bypass

Cited by 34 publications

References 47 publications

Risk Factors for Kidney Stone Formation following Bariatric Surgery

Risk Factors for Kidney Stone Formation following Bariatric Surgery

72-Year-Old Woman With Fatigue, Confusion, and Severe Acute Renal Failure

New insights in the mechanisms of weight‐loss maintenance: Summary from a Pennington symposium

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