Renal complications of jejuno-ileal bypass for obesity

Mole, David R.; Tomson, Charles; Mortensen, N. J. McC.; Winearls, Christopher G.

doi:10.1093/qjmed/94.2.69

Cited by 66 publications

(44 citation statements)

References 33 publications

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“…This leads to increased oxalate delivery to the colon where it is absorbed, while calcium is excreted along with the fat. 12 As oxalate cannot be metabolized, these larger quantities of oxalate are cleared unaltered by the kidneys thereby increasing urinary concentrations. Indeed, 47% of RYGB patients manifest hyperoxaluria compared to just 10.5% in obese controls, predisposing this population to the development of calcium oxalate type stones.…”

Section: Discussionmentioning

confidence: 99%

Long-term incidence of urolithiasis post-bariatric surgery

Haddad

Scheffler

Elkoushy

et al. 2014

CUAJ

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Introduction: The risk of urolithiasis post-Roux-en-Y gastric bypass (RYGB) surgery is higher when compared to the general population. Calcium and vitamin D supplementation is routinely prescribed to these patients, yet compliance with these supplements is unknown. The aim of this study was to assess the incidence of symptomatic de novo urolithiasis post-RYGB and compliance with calcium and vitamin D supplementation. Methods: A standardized telephone questionnaire was administered to patients who underwent RYGB between 1996 and 2011. Personal and medical histories were obtained with emphasis on episodes of symptomatic urolithiasis and calcium and vitamin D supplementation. Results: The response rate was 48% with 478 patients completing the telephone questionnaire. After a mean follow-up of 7.0 years (range: 1-15), the incidence of post-RYGB symptomatic urolithiasis was 7.3%, while the rate of de novo symptomatic urolithiasis was 5%. The overall median time to present with symptomatic urolithiasis was 3.1 years, with 3.3 years for de novo stone-formers, and 2.0 years for recurrent stone-formers (p = 0.38). In de novo stone-formers, 33% presented with symptomatic urolithiasis 4 to 14 years postoperatively. Compliance with calcium and vitamin D supplementation was 56% and 51%, respectively. Conclusions: Despite recall bias and lack of confirmatory imaging studies, a high postoperative incidence of symptomatic urolithiasis was found in a large sample of post-RYGB patients. A third of patients with de novo stones, presented with symptomatic urolithiasis 4 to 14 years postoperatively. Compliance with postoperative calcium and vitamin D supplementation was poor and needs improvement.

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Section: Discussionmentioning

confidence: 99%

Long-term incidence of urolithiasis post-bariatric surgery

Haddad

Scheffler

Elkoushy

et al. 2014

CUAJ

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“…Oxalate nephropathy is characterized by tubular crystalline deposits of calcium oxalate in kidney tissue, which lead to tubular injury, interstitial fibrosis, and progressive renal insufficiency [20]. Nasr et al [2] reported 11 cases of oxalate nephropathy after R-Y gastric bypass, in 8 patients with morbid obesity and 3 patients with gastric cancer, and renal biopsies revealed diffuse tubular degenerative changes, tubular calcium oxalate deposits, and interstitial scarring, findings which were similar to those in our renal biopsied case.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of postoperative nephrolithiasis and renal dysfunction in gastric cancer patients

et al. 2012

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Background Roux-en-Y (R-Y) gastric bypass, also known as bariatric surgery, sometimes causes postoperative hyperoxaluria and subsequent oxalate nephrolithiasis in obese patients. In this study, we retrospectively investigated the frequency of occurrence of nephrolithiasis and renal dysfunction in postoperative gastric cancer patients with respect to the surgical procedures employed. Methods Two hundred and twenty-six consecutive gastric cancer patients, who underwent distal gastrectomy with Billroth-I reconstruction (DGBI, 60 patients), distal gastrectomy with R-Y reconstruction (DGRY, 81 patients), and total gastrectomy with R-Y reconstruction (TGRY, 85 patients), were investigated for postoperative nephrolithiasis and renal dysfunction. We also examined the risk factors for postoperative nephrolithiasis in these patients with gastric cancer. Results Nephrolithiasis was detected in 3 (5 %), 7 (9 %), and 21 (25 %) patients in the DGBI, DGRY, and TGRY groups, respectively. There were significant differences in the frequency of nephrolithiasis between the DGBI and TGRY groups (p = 0.004), and between the DGRY and TGRY groups (p = 0.011), but there was no significant difference between the DGBI and DGRY groups. Multivariate logistic regression analysis revealed that gender and extent of gastrectomy were independent risk factors associated with nephrolithiasis. Renal dysfunction was found in 5 patients (6 %) in the TGRY group, but was not found in either the DGBI or the DGRY group. Nephrolithiasis was detected in all these 5 patients, and a renal biopsy performed in one patient revealed the presence of intratubular calcium oxalate crystals with chronic tubulointerstitial nephritis. Conclusion Total gastrectomy with R-Y reconstruction was an independent predictive factor for nephrolithiasis in patients with gastric cancer.

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“…Mole et al (4) described eight cases of renal failure after JI bypass and reviewed 18 previously reported cases. Histologic evaluation was available for 17 of the 26 patients and revealed findings of tubular calcium oxalate crystals, frequently accompanied by "chronic interstitial nephritis."…”

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confidence: 99%

Oxalate Nephropathy Complicating Roux-en-Y Gastric Bypass

Nasr

D’Agati

Said

et al. 2008

Clinical Journal of the American Society of Nephrology

183

143

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Background and objectives: The most common bariatric surgery is Roux-en-Y gastric bypass (RYGB), which has been associated with hyperoxaluria and nephrolithiasis. We report a novel association of RYGB with renal insufficiency as a result of oxalate nephropathy.Design, setting, participants, & measurements: Eleven cases of oxalate nephropathy after RYGB were identified from the Renal Pathology Laboratory of Columbia University. The clinical features, pathologic findings, and outcomes are described.Results: Patients were predominantly white (72.7%) with a mean age of 61.3 yr. Indications for RYGB included morbid obesity (eight patients) and reconstruction after total gastrectomy for gastric cancer (three patients). All 11 patients had a history of hypertension, and 9 were diabetic. Patients presented with acute renal failure, often superimposed on mild chronic renal insufficiency (n ‫؍‬ 7), at a median of 12 mo after RYGB. The mean creatinine at baseline, at discovery of acute renal failure, and at biopsy was 1.5, 5.0, and 6.5 mg/dl, respectively. Renal biopsies revealed diffuse tubular degenerative changes, abundant tubular calcium oxalate deposits, and varying degrees of tubulointerstitial scarring. In addition, seven biopsies had underlying diabetic glomerulosclerosis and two had glomerulosclerosis attributable to obesity and hypertension. Eight of 11 patients rapidly progressed to ESRD and required hemodialysis at a mean of 3.2 wk after renal biopsy. The remaining three patients were left with significant chronic kidney disease.Conclusions: Oxalate nephropathy is an underrecognized complication of RYGB and typically results in rapid progression to ESRD. Patients with pre-existing renal disease may be at higher risk for this complication.

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Renal complications of jejuno-ileal bypass for obesity

Cited by 66 publications

References 33 publications

Long-term incidence of urolithiasis post-bariatric surgery

Long-term incidence of urolithiasis post-bariatric surgery

Evaluation of postoperative nephrolithiasis and renal dysfunction in gastric cancer patients

Oxalate Nephropathy Complicating Roux-en-Y Gastric Bypass

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