Nephrolithiasis After Bariatric Surgery for Obesity
Section snippets
Surgical Options for Obesity Treatment
The bariatric procedures currently used promote weight loss via varied mechanisms (Fig. 1). Restrictive procedures such as vertical banded gastroplasty (VBG) and laparoscopic adjustable gastric band (LAGB) each limit caloric intake by the physical restriction imposed by the band on dietary intake. The VBG consists of a stapled proximal gastric pouch with a fixed and nonadjustable outlet created by a mesh band or Silastic (Dow Corning, Midland, MI) ring. Although still performed, poor long-term
Complications of Obesity Surgery
The current bariatric procedures have been deemed relatively safe and effective, even though both short-term and long-term complications have been recognized, including osteopenia, osteomalacia, and, more rarely, neurologic disorders.22, 23, 24, 25, 26, 27, 28 Overall morbidity rates vary from 10% to 23% depending on the surgical procedure performed, although these have been declining as a result of increased attention being paid to potential metabolic consequences (eg, calcium and other
Hyperoxaluria After Jejunoileal Bypass: Lessons From the Past
Historically, nephrolithiasis was a well-recognized complication of bariatric surgery. In particular the development of calcium oxalate stones was a serious complication of jejunoileal (JI) bypass surgery performed in the 1970s for the management of obesity and hypercholesterolemia. This risk for nephrolithiasis, renal failure, and other life-threatening complications such as liver disease led to the abandonment of this surgery more than 20 years ago.32
The best evidence regarding the true risk
Renal Stones After RYGB
Little is known about the impact of most currently offered bariatric surgeries on the risk for nephrolithiasis. Because obesity and insulin resistance have been implicated as risk factors for nephrolithiasis, especially uric acid stones, one might reasonably hypothesize that RYGB could ameliorate kidney stone risk.8, 29 Further, the RYGB surgery with a Roux limb less than 150 cm in length generally has been believed not to cause fat malabsorption, thought to be a critical factor in the
Hyperoxaluria After RYGB
To get a better sense regarding how common hyperoxaluria might be in the total group of patients who undergo RYGB, we next completed a small pilot study of patients randomly selected before (n = 20), 6 months after (n = 8), and 12 months after (n = 13) proximal RYGB. At baseline hyperoxaluria was rare (mean oxalate, 0.35 mmol/d), and urinary calcium oxalate supersaturation was not increased above the reference mean (Fig. 3). Urinary composition was not changed significantly in the 6-month
Treatment of Nephrolithiasis after RYGB
Typical treatment strategies for enteric hyperoxaluria, as described earlier, are prescription of a low-fat, low-oxalate diet, generous fluid intake, use of oral oxalate binders such as calcium, and potassium citrate as a crystallization inhibitor. In practice, these dietary modifications may be quite difficult to implement. For example, many patients have learned to alter their eating patterns after RYGB and consume many small meals and/or snacks to avoid dumping symptoms. The use of oxalate
Conclusions and Future Directions
As a first step, it will be vital to define the scope of the problem. How common is hyperoxaluria after RYGB or other forms of bariatric surgery? How many of these patients develop stones and/or renal damage? Based on the preliminary data described earlier, it seems likely that the prevalence of hyperoxaluria and nephrolithiasis will be significant. Therefore, studies that can identify improved strategies to decrease urinary oxalate levels among the ever-expanding pool of patients undergoing
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Cited by (45)
Nephrolithiasis after bariatric surgery: A comparison of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy
2020, American Journal of SurgeryChronic Kidney Disease and Gastrointestinal Disorders
2019, Chronic Renal DiseaseBariatric Surgery and Kidney-Related Outcomes
2017, Kidney International ReportsNephrolithiasis after bariatric surgery: A review of pathophysiologic mechanisms and procedural risk
2016, International Journal of SurgeryCitation Excerpt :One aspect of restrictive procedures that is of concern is low urine volume in the post-operative period which predisposes to stone formation, but as seen above (see 2.1.3), the net effect is reduced by concurrent hypocalciuria. Treatment for hyperoxaluria, generally prescribed to those who have undergone RYGB, include a low-fat, low-oxalate diet, increased fluid intake [55], with potassium citrate salts the most common method of correcting hypocitraturia [11,15,27]. Additionally, the use of calcium citrate salts is advocated [36] based on its dual effect of decreasing intestinal oxalate absorption and increasing urinary citrate, and thus, increasing the solubility of urinary calcium.
Prospective evaluation of urinary metabolic indices in severely obese adolescents after weight loss surgery
2016, Surgery for Obesity and Related DiseasesCitation Excerpt :In addition, the metabolic syndrome can alter the renal acid-base metabolism, with a resultant lower urine pH increasing the risk of uric acid stone formation [4]. Moreover, both medical and surgical weight loss interventions have been associated with the increased risk of kidney stones [9–12]. Several urinary metabolic studies have been performed in obese adults to assess lithogenic risk factors.
Nephrolithiasis for the primary care physician
2015, Disease-a-Month
Supported by grants from the National Institutes of Health (DK 73354, AR 30582, DK 77669, AT 002534, and DK 39337), the Oxalosis and Hyperoxaluria Foundation, and Mayo Foundation.