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Hyperoxaluria in kidney stone formers treated with modern bariatric surgery.

Abstract

PURPOSE

Nephrolithiasis and renal failure secondary to severe hyperoxaluria were complications of jejunoileal bypass for obesity, leading to the discontinuation of this procedure in the United States in 1980. Bariatric procedures currently in use have not been adequately evaluated for this complication.

MATERIALS AND METHODS

We compared 24-hour urine chemistry studies of 132 patients with nephrolithiasis who had undergone bariatric surgery with the urine chemistry studies of patients who had undergone jejunoileal bypass, those with routine kidney stones and normal subjects. The primary aim was to determine if hyperoxaluria developed in patients who underwent bariatric surgery and had kidney stones as had been seen with jejunoileal bypass.

RESULTS

Patients who have undergone modern bariatric surgery had an adjusted mean urine oxalate excretion of 83 mg per day compared to 39 mg per day for routine kidney stone formers and 34 mg per day for normal subjects (p <0.001 for both comparisons), but not quite as high as that found in patients treated with jejunoileal bypass (102 mg per day, p <0.001). Urine supersaturation of calcium oxalate, the main driving force for calcium oxalate stone formation, was higher in patients treated with bariatric surgery compared to routine kidney stone formers and normal subjects (p <0.001 for both comparisons).

CONCLUSIONS

Hyperoxaluria is the most significant abnormality of urine chemistry studies in patients with kidney stones who have undergone bariatric surgery. Many of these patients have a degree of hyperoxaluria that could lead to kidney failure. Further studies are required to determine the prevalence of this problem in patients who have undergone bariatric surgery.

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  • Authors+Show Affiliations

    ,

    Litholink Corporation and the Section of Nephrology, University of Chicago, Chicago, Illinois, USA. jasplin@litholink.com

    Source

    The Journal of urology 177:2 2007 Feb pg 565-9

    MeSH

    Bariatric Surgery
    Female
    Humans
    Hyperoxaluria
    Jejunoileal Bypass
    Kidney Calculi
    Male
    Multivariate Analysis
    Obesity
    Oxalates

    Pub Type(s)

    Comparative Study
    Journal Article
    Research Support, N.I.H., Extramural

    Language

    eng

    PubMed ID

    17222634

    Citation

    Asplin, John R., and Fredric L. Coe. "Hyperoxaluria in Kidney Stone Formers Treated With Modern Bariatric Surgery." The Journal of Urology, vol. 177, no. 2, 2007, pp. 565-9.
    Asplin JR, Coe FL. Hyperoxaluria in kidney stone formers treated with modern bariatric surgery. J Urol. 2007;177(2):565-9.
    Asplin, J. R., & Coe, F. L. (2007). Hyperoxaluria in kidney stone formers treated with modern bariatric surgery. The Journal of Urology, 177(2), pp. 565-9.
    Asplin JR, Coe FL. Hyperoxaluria in Kidney Stone Formers Treated With Modern Bariatric Surgery. J Urol. 2007;177(2):565-9. PubMed PMID: 17222634.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Hyperoxaluria in kidney stone formers treated with modern bariatric surgery. AU - Asplin,John R, AU - Coe,Fredric L, PY - 2006/02/22/received PY - 2007/1/16/pubmed PY - 2007/2/28/medline PY - 2007/1/16/entrez SP - 565 EP - 9 JF - The Journal of urology JO - J. Urol. VL - 177 IS - 2 N2 - PURPOSE: Nephrolithiasis and renal failure secondary to severe hyperoxaluria were complications of jejunoileal bypass for obesity, leading to the discontinuation of this procedure in the United States in 1980. Bariatric procedures currently in use have not been adequately evaluated for this complication. MATERIALS AND METHODS: We compared 24-hour urine chemistry studies of 132 patients with nephrolithiasis who had undergone bariatric surgery with the urine chemistry studies of patients who had undergone jejunoileal bypass, those with routine kidney stones and normal subjects. The primary aim was to determine if hyperoxaluria developed in patients who underwent bariatric surgery and had kidney stones as had been seen with jejunoileal bypass. RESULTS: Patients who have undergone modern bariatric surgery had an adjusted mean urine oxalate excretion of 83 mg per day compared to 39 mg per day for routine kidney stone formers and 34 mg per day for normal subjects (p <0.001 for both comparisons), but not quite as high as that found in patients treated with jejunoileal bypass (102 mg per day, p <0.001). Urine supersaturation of calcium oxalate, the main driving force for calcium oxalate stone formation, was higher in patients treated with bariatric surgery compared to routine kidney stone formers and normal subjects (p <0.001 for both comparisons). CONCLUSIONS: Hyperoxaluria is the most significant abnormality of urine chemistry studies in patients with kidney stones who have undergone bariatric surgery. Many of these patients have a degree of hyperoxaluria that could lead to kidney failure. Further studies are required to determine the prevalence of this problem in patients who have undergone bariatric surgery. SN - 0022-5347 UR - https://www.unboundmedicine.com/medline/citation/17222634/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5347(06)02508-0 DB - PRIME DP - Unbound Medicine ER -