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Hyperoxaluria after modern bariatric surgery: case series and literature review.
Int Urol Nephrol 2010; 42(2):369-74IU

Abstract

INTRODUCTION

Two recent studies have shown that modern bariatric surgery leads to significant hyperoxaluria and risk of nephrolithiasis. However, neither report evaluates the use or effects of stone risk modifying agents in these patients. We sought to determine the impact of medical management on stone risk profile in patients who have undergone Roux-en-y gastric bypass.

MATERIALS AND METHODS

Twenty-four-hour urine collections of all patients referred to a tertiary clinic for nephrolithiasis in the past 4 years were reviewed. Those patients with severe (>75 mg/day) hyperoxaluria were identified. Retrospective chart review was performed to identify those patients with a history of bariatric surgery. Student's t-test was used to compare mean urinary parameters between bariatric and non-bariatric patients.

RESULTS

Out of all stone formers within our 24-h urine collection database, 39 patients had severe hyperoxaluria (oxalate >75 mg/day). Twenty-six patients had complete information for review. Five patients had a history of bariatric surgery. Compared with non-bariatric patients, those with a history of bariatric surgery had increased use of oral calcium (80 vs. 28%) and citrate supplementation (100 vs. 47%), higher urinary oxalate (129 vs. 91 mg/day) and volume (2.9 vs. 2.4 L/day), lower urinary citrate (390 vs. 800 mg/day) and calcium (155 vs. 235 mg/day), and a decreased supersaturation of calcium oxalate (6.7 vs. 11).

CONCLUSIONS

Appropriate medical management, in particular oral calcium and citrate supplementation, and perhaps most importantly aggressive fluid intake can mitigate some of the effects of enteric hyperoxaluria caused by fat malabsorption after modern bariatric surgery.

Authors+Show Affiliations

Department of Urology, University of California San Francisco, 400 Parnassus Ave, A-631, San Francisco, CA 94143, USA. jwhitson@urology.ucsf.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

19572208

Citation

Whitson, Jared M., et al. "Hyperoxaluria After Modern Bariatric Surgery: Case Series and Literature Review." International Urology and Nephrology, vol. 42, no. 2, 2010, pp. 369-74.
Whitson JM, Stackhouse GB, Stoller ML. Hyperoxaluria after modern bariatric surgery: case series and literature review. Int Urol Nephrol. 2010;42(2):369-74.
Whitson, J. M., Stackhouse, G. B., & Stoller, M. L. (2010). Hyperoxaluria after modern bariatric surgery: case series and literature review. International Urology and Nephrology, 42(2), pp. 369-74. doi:10.1007/s11255-009-9602-5.
Whitson JM, Stackhouse GB, Stoller ML. Hyperoxaluria After Modern Bariatric Surgery: Case Series and Literature Review. Int Urol Nephrol. 2010;42(2):369-74. PubMed PMID: 19572208.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hyperoxaluria after modern bariatric surgery: case series and literature review. AU - Whitson,Jared M, AU - Stackhouse,G Bennett, AU - Stoller,Marshall L, Y1 - 2009/07/02/ PY - 2009/04/30/received PY - 2009/06/06/accepted PY - 2009/7/3/entrez PY - 2009/7/3/pubmed PY - 2010/11/17/medline SP - 369 EP - 74 JF - International urology and nephrology JO - Int Urol Nephrol VL - 42 IS - 2 N2 - INTRODUCTION: Two recent studies have shown that modern bariatric surgery leads to significant hyperoxaluria and risk of nephrolithiasis. However, neither report evaluates the use or effects of stone risk modifying agents in these patients. We sought to determine the impact of medical management on stone risk profile in patients who have undergone Roux-en-y gastric bypass. MATERIALS AND METHODS: Twenty-four-hour urine collections of all patients referred to a tertiary clinic for nephrolithiasis in the past 4 years were reviewed. Those patients with severe (>75 mg/day) hyperoxaluria were identified. Retrospective chart review was performed to identify those patients with a history of bariatric surgery. Student's t-test was used to compare mean urinary parameters between bariatric and non-bariatric patients. RESULTS: Out of all stone formers within our 24-h urine collection database, 39 patients had severe hyperoxaluria (oxalate >75 mg/day). Twenty-six patients had complete information for review. Five patients had a history of bariatric surgery. Compared with non-bariatric patients, those with a history of bariatric surgery had increased use of oral calcium (80 vs. 28%) and citrate supplementation (100 vs. 47%), higher urinary oxalate (129 vs. 91 mg/day) and volume (2.9 vs. 2.4 L/day), lower urinary citrate (390 vs. 800 mg/day) and calcium (155 vs. 235 mg/day), and a decreased supersaturation of calcium oxalate (6.7 vs. 11). CONCLUSIONS: Appropriate medical management, in particular oral calcium and citrate supplementation, and perhaps most importantly aggressive fluid intake can mitigate some of the effects of enteric hyperoxaluria caused by fat malabsorption after modern bariatric surgery. SN - 1573-2584 UR - https://www.unboundmedicine.com/medline/citation/19572208/Hyperoxaluria_after_modern_bariatric_surgery:_case_series_and_literature_review_ L2 - https://doi.org/10.1007/s11255-009-9602-5 DB - PRIME DP - Unbound Medicine ER -