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Enteric hyperoxaluria, nephrolithiasis, and oxalate nephropathy: potentially serious and unappreciated complications of Roux-en-Y gastric bypass.

Abstract

BACKGROUND

Neither the presence nor prevalence of enteric hyperoxaluria has been recognized after Roux-en-Y gastric bypass (RYGBP). We have noted a high rate of oxalate nephrolithiasis and even 2 patients with oxalate nephropathy in this patient population postoperatively. Our aim was to determine the frequency of the occurrence and effects of enteric hyperoxaluria after RYGBP.

METHODS

Retrospective review of all patients at our institution diagnosed with calcium oxalate nephrolithiasis or oxalate nephropathy after standard (n = 14) or distal (n = 9) RYGBP. The mean postoperative follow-up was 55 months.

RESULTS

A total of 23 patients (14 men and 9 women; mean age 45 years; mean preoperative body mass index 55 kg/m(2)) developed enteric hyperoxaluria after RYGBP, defined by the presence of oxalate nephropathy (n = 2) or calcium oxalate nephrolithiasis (n = 21) and increased 24-hour excretion of urinary oxalate and/or calcium oxalate supersaturation. Enteric hyperoxaluria was recognized after a mean weight loss of 46 kg at 29 months (range 2-85) after RYGBP. Two patients developed renal failure and required chronic hemodialysis. Of the 21 patients with nephrolithiasis, 14 had no history of nephrolithiasis preoperatively, and 19 of 21 required lithotripsy or other intervention. Of the 23 patients, 20 tested had increased oxalate excretion, and 14 of 15 tested had high urine calcium oxalate supersaturation.

CONCLUSION

Enteric hyperoxaluria, nephrolithiasis, and oxalate nephropathy must be considered with the other risks of RYGBP. Efforts should be made to identify factors that predispose patients to developing hyperoxaluria.

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  • Authors+Show Affiliations

    ,

    Mayo Medical School, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.

    , , ,

    Source

    MeSH

    Adult
    Female
    Follow-Up Studies
    Gastric Bypass
    Humans
    Hyperoxaluria
    Kidney Calculi
    Lithotripsy
    Male
    Middle Aged
    Obesity, Morbid
    Oxalates
    Renal Dialysis
    Renal Insufficiency
    Retrospective Studies
    Stents

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    16925274

    Citation

    Nelson, Wayne K., et al. "Enteric Hyperoxaluria, Nephrolithiasis, and Oxalate Nephropathy: Potentially Serious and Unappreciated Complications of Roux-en-Y Gastric Bypass." Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, vol. 1, no. 5, 2005, pp. 481-5.
    Nelson WK, Houghton SG, Milliner DS, et al. Enteric hyperoxaluria, nephrolithiasis, and oxalate nephropathy: potentially serious and unappreciated complications of Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2005;1(5):481-5.
    Nelson, W. K., Houghton, S. G., Milliner, D. S., Lieske, J. C., & Sarr, M. G. (2005). Enteric hyperoxaluria, nephrolithiasis, and oxalate nephropathy: potentially serious and unappreciated complications of Roux-en-Y gastric bypass. Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, 1(5), pp. 481-5.
    Nelson WK, et al. Enteric Hyperoxaluria, Nephrolithiasis, and Oxalate Nephropathy: Potentially Serious and Unappreciated Complications of Roux-en-Y Gastric Bypass. Surg Obes Relat Dis. 2005;1(5):481-5. PubMed PMID: 16925274.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Enteric hyperoxaluria, nephrolithiasis, and oxalate nephropathy: potentially serious and unappreciated complications of Roux-en-Y gastric bypass. AU - Nelson,Wayne K, AU - Houghton,Scott G, AU - Milliner,Dawn S, AU - Lieske,John C, AU - Sarr,Michael G, Y1 - 2005/08/26/ PY - 2005/05/13/received PY - 2005/06/27/revised PY - 2005/07/07/accepted PY - 2006/8/24/pubmed PY - 2006/10/13/medline PY - 2006/8/24/entrez SP - 481 EP - 5 JF - Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery JO - Surg Obes Relat Dis VL - 1 IS - 5 N2 - BACKGROUND: Neither the presence nor prevalence of enteric hyperoxaluria has been recognized after Roux-en-Y gastric bypass (RYGBP). We have noted a high rate of oxalate nephrolithiasis and even 2 patients with oxalate nephropathy in this patient population postoperatively. Our aim was to determine the frequency of the occurrence and effects of enteric hyperoxaluria after RYGBP. METHODS: Retrospective review of all patients at our institution diagnosed with calcium oxalate nephrolithiasis or oxalate nephropathy after standard (n = 14) or distal (n = 9) RYGBP. The mean postoperative follow-up was 55 months. RESULTS: A total of 23 patients (14 men and 9 women; mean age 45 years; mean preoperative body mass index 55 kg/m(2)) developed enteric hyperoxaluria after RYGBP, defined by the presence of oxalate nephropathy (n = 2) or calcium oxalate nephrolithiasis (n = 21) and increased 24-hour excretion of urinary oxalate and/or calcium oxalate supersaturation. Enteric hyperoxaluria was recognized after a mean weight loss of 46 kg at 29 months (range 2-85) after RYGBP. Two patients developed renal failure and required chronic hemodialysis. Of the 21 patients with nephrolithiasis, 14 had no history of nephrolithiasis preoperatively, and 19 of 21 required lithotripsy or other intervention. Of the 23 patients, 20 tested had increased oxalate excretion, and 14 of 15 tested had high urine calcium oxalate supersaturation. CONCLUSION: Enteric hyperoxaluria, nephrolithiasis, and oxalate nephropathy must be considered with the other risks of RYGBP. Efforts should be made to identify factors that predispose patients to developing hyperoxaluria. SN - 1550-7289 UR - https://www.unboundmedicine.com/medline/citation/16925274/Enteric_hyperoxaluria_nephrolithiasis_and_oxalate_nephropathy:_potentially_serious_and_unappreciated_complications_of_Roux_en_Y_gastric_bypass_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1550-7289(05)00604-0 DB - PRIME DP - Unbound Medicine ER -