The Effect of Restrictive Bariatric Surgery on Urolithiasis

Chen, Tony; Godebu, Elana; Horgan, Santiago; Mirheydar, Hossein; Sur, Roger L.

doi:10.1089/end.2012.0408

Cited by 34 publications

(38 citation statements)

References 13 publications

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“…[4][5][6] RYGB increases urinary oxalate excretion and decreases urinary citrate, conditions commonly associated with the development of calcium oxalate stones. [7][8][9] Indeed, calcium oxalate stones comprise 75% to 80% of all stones in RYGB patients, implicating hyperoxaluria in the pathogenesis of urolithiasis.…”

Section: Introductionmentioning

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: Introductionmentioning

confidence: 99%

Long-term incidence of urolithiasis post-bariatric surgery

Haddad

Scheffler

Elkoushy

et al. 2014

CUAJ

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“…However, recent data suggest that modern bariatric procedures, such as Roux-en-Y bypass, may also impart a twofold increased risk of nephrolithiasis, while 20-75% may have hyperoxaluria, including 20% with very high urine oxalate levels, also putting them at considerable risk of oxalate nephropathy (Table 2) (2,(5)(6)(7)(8)(9)(10)(11)(12). Purely restrictive bariatric procedures, such as gastric banding, may not increase oxalate excretion, yet more data are needed (Table 2) (13)(14)(15)(16). Morbidly obese patients are increasingly encouraged to consider bariatric surgery in order to meet body mass index thresholds for renal or other solid-organ transplantation.…”

Section: Introductionmentioning

confidence: 99%

Enteric Oxalate Nephropathy in the Renal Allograft: An Underrecognized Complication of Bariatric Surgery

Troxell

Houghton

Hawkey³

et al. 2013

American Journal of Transplantation

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Enteric hyperoxalosis is a recognized complication of bariatric surgery, with consequent oxalate nephropathy leading to chronic kidney disease and occasionally end-stage renal failure. In patients with prior gastrointestinal bypass surgery, renal allografts are also at risk of oxalate nephropathy. Further, transplant recipients may be exposed to additional causes of hyperoxalosis. We report two cases of renal allograft oxalate nephropathy in patients with remote histories of bariatric surgery. Conservative management led to improvement of graft function in one patient, while the other patient returned to dialysis. Interpretation of serologic, urine and biopsy studies is complicated by oxalate accumulation in chronic renal failure, and heightened excretion in the early posttransplant period. A high index of suspicion and careful clinicopathologic correlation on the part of transplant nephrologists and renal pathologists are required to recognize and treat allograft oxalate nephropathy. As the incidence of obesity and pretransplant bariatric surgery increases in the transplant population, allograft oxalate nephropathy is likely to be an increasing cause of allograft dysfunction.

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“…Restrictive procedures (LAGB and SG) had a much lower stone incidence rate of 1.3% (8/618) compared with obese controls 4.6% (258/5569) during a similar 2-year time frame. 35,36 The literature on the incidence of nephrolithiasis after RYGB consists of only a small sample of studies and more efforts are needed to delineate direct causation. Matlaga et al presented the first large-scale claims data report in a casecontrol study of 4639 patients in which they found a 7.65% incidence of urolithiasis in post-RYGB patients versus 4.63% in obese patients in the control group ( p < 0.0001).…”

Section: Resultsmentioning

confidence: 99%

“…Although taken from a small sample, the combined risk of 1.3% (n = 618) appears to be lower than the risk present in obese control individuals of 4.6% (n = 5569). 35,36 Strategies, limitations, and solutions to reduce calcium oxalate stone risk after RYGB Largely, the key strategies to prevent kidney stones after bariatric surgery are similar to those recommended to all stone formers and a summary is provided in Table 2. As discussed above, low urine volume status in bariatric surgical patients can significantly increase the risk of nephrolithiasis due to supersaturation of stone-forming solute particles.…”

Section: Resultsmentioning

confidence: 99%

Kidney Stones After Bariatric Surgery: Risk Assessment and Mitigation

Espino-Grosso

Canales

2017

Bariatric Surgical Practice and Patient Care

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Obesity is rampant across the spectrum of age, gender, and race in the Unites States. Paralleling this epidemic, kidney stone prevalence is also rising, affecting nearly 1 in 11 individuals. Bariatric surgical procedures, such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), are the most effective weight loss options for morbidly obese or severely obese individuals with comorbidities. A number of studies have linked kidney stone development to bariatric surgical history, particularly RYGB, which portends up to a threefold increase in calcium oxalate stone risk compared with age-matched, obese controls. Stone development after malabsorptive (RYGB) and restrictive (SG) bariatric procedures are driven primarily by alterations in 24-h urine profiles, such as increased urinary oxalate, decreased urine volume, and reduced urinary citrate levels-all of which have been linked to increased kidney stone risk. What clinical recommendations, if any, can be given to reduce kidney stone risk in bariatric kidney stone patients? This review provides not only updated stone incidence and 24-h urine data in this population, but also reassurance-the metabolic alterations that result from bariatric surgery can be successfully mitigated by increased provider awareness, patient education, and a combination of dietary and pharmacological adjustments.

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The Effect of Restrictive Bariatric Surgery on Urolithiasis

Cited by 34 publications

References 13 publications

Long-term incidence of urolithiasis post-bariatric surgery

Long-term incidence of urolithiasis post-bariatric surgery

Enteric Oxalate Nephropathy in the Renal Allograft: An Underrecognized Complication of Bariatric Surgery

Kidney Stones After Bariatric Surgery: Risk Assessment and Mitigation

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