Background
Hyperoxaluria and increased calcium oxalate stone formation occur after Roux-en-Y
gastric bypass (RYGB) surgery for morbid obesity. The etiology of this hyperoxaluria
is unknown. We hypothesized that after bariatric surgery, intestinal hyperabsorption
of oxalate contributes to increases in plasma oxalate and urinary calcium oxalate
supersaturation.
Methods
We prospectively examined oxalate metabolism in 11 morbidly obese subjects before
and 6 and 12 months after RYGB (n = 9) and biliopancreatic diversion-duodenal switch (BPD-DS) (n = 2). We measured 24-hour urinary supersaturations for calcium oxalate, apatite,
brushite, uric acid, and sodium urate; fasting plasma oxalate; 72-hour fecal fat;
and increases in urine oxalate following an oral oxalate load.
Results
Six and 12 months after RYGB, plasma oxalate and urine calcium oxalate supersaturation
increased significantly compared with similar measurements obtained before surgery
(all P ≤ .02). Fecal fat excretion at 6 and 12 months was increased (P = .026 and .055, 0 vs 6 and 12 months). An increase in urine oxalate excretion after
an oral dose of oxalate was observed at 6 and 12 months (all P ≤ .02). Therefore, after bariatric surgery, increases in fecal fat excretion, urinary
oxalate excretion after an oral oxalate load, plasma oxalate, and urinary calcium
oxalate supersaturation values were observed.
Conclusion
Enteric hyperoxaluria is often present in patients after the operations of RYGB and
BPD-DS that utilize an element of intestinal malabsorption as a mechanism for weight
loss.
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References
- Prevalence and trends in obesity among US adults, 1999–2008.JAMA. 2010; 303: 235-241
- Trends in bariatric surgical procedures.JAMA. 2005; 294: 1909-1917
- Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel.Ann Intern Med. 1991; 115: 956-961
- Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. The evidence report. National Institutes of Health.Obes Res. 1998; 6: S51-209S
- Surgical approaches to obesity.Mayo Clin Proc. 2006; 81: S18-S24
- Nephrolithiasis after bariatric surgery for obesity.Semin Nephrol. 2008; 28: 163-173
- Long-term mortality after gastric bypass surgery.N Engl J Med. 2007; 357: 753-761
- Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery.N Engl J Med. 2004; 351: 2683-2693
- Effects of bariatric surgery on mortality in Swedish obese subjects.N Engl J Med. 2007; 357: 741-752
- Enteric hyperoxaluria, nephrolithiasis, and oxalate nephropathy: potentially serious and unappreciated complications of roux-en-Y gastric bypass.Surg Obes Relat Dis. 2005; 1: 481-485
- Hyperoxaluric nephrolithiasis is a complication of Roux-en-Y gastric bypass surgery.Kidney Int. 2007; 72: 100-107
- Nephrolithiasis after bariatric surgery for obesity.Semin Nephrol. 2008; 28: 163-173
- Bariatric surgery and renal function: a precarious balance between benefit and harm.Nephrol Dial Transplant. 2010; 25: 3142-3147
- Hyperoxaluria in kidney stone formers treated with modern bariatric surgery.J Urol. 2007; 177: 565-569
- Lithogenic risk factors in the morbidly obese population.J Urol. 2008; 179: 1401-1406
- Roux-en-Y gastric bypass is associated with early increased risk factors for development of calcium oxalate nephrolithiasis.J Am Coll Surg. 2008; 206: 1145-1153
- Bariatric surgery, hyperoxaluria, and nephrolithiasis: a plea for close postoperative management of risk factors.Kidney Int. 2007; 72: 8-10
- Gastric bypass procedures and renal calculi—how should we counsel patients and bariatric surgeons?.J Urol. 2009; 182: 2105-2106
- Effect of gastric bypass surgery on kidney stone disease.J Urol. 2009; 181: 2573-2577
- Oxalate nephropathy complicating Roux-en-Y Gastric Bypass: an underrecognized cause of irreversible renal failure.Clin J Am Soc Nephrol. 2008; 3: 1676-1683
- Bariatric surgery in the 1990's.Swiss Surg. 2001; 7: 11-15
- Bariatric surgery for morbid obesity: pre-operative assessment, surgical techniques and post-operative monitoring.J Int Med Res. 2009; 37: 1632-1645
- Development of a model for a structured support group for patients following bariatric surgery.Obes Surg. 2004; 14: 103-106
- EQUIL2: a BASIC computer program for the calculation of urinary saturation.J Urol. 1985; 134: 1242-1244
- Use of recovery biomarkers to calibrate nutrient consumption self-reports in the Women's Health Initiative.Am J Epidemiol. 2008; 167: 1247-1259
- Measurement characteristics of the Women's Health Initiative food frequency questionnaire.Ann Epidemiol. 1999; 9: 178-187
- Estimation of the correlation between nutrient intake measures under restricted sampling.Biometrics. 1999; 55: 711-717
- Sensitive spectrophotometric assay for plasma oxalate.Clin Chem. 2005; 51: 2377-2380
- Hyperoxaluria is a long-term consequence of Roux-en-Y Gastric bypass: a 2-year prospective longitudinal study.J Am Coll Surg. 2010; 211: 8-15
- Renal and urologic complications of inflammatory bowel disease.Am J Gastroenterol. 1998; 93: 504-514
- The importance of the colon in calcium absorption following small-intestinal resection.Scand J Gastroenterol. 1980; 15: 55-60
- Oxalate nephropathy due to gastrointestinal disorders.Can Med Assoc J. 1981; 124: 729-733
- Renal damage with intestinal bypass.Ann Intern Med. 1978; 89: 594-599
- Evidence for excessive absorption of oxalate by the colon in enteric hyperoxaluria.Scand J Gastroenterol. 1978; 13: 187-192
- Urolithiasis complicating inflammatory bowel disease.J Urol. 1992; 148: 974-978
- Restitution of barrier and transport function of porcine colon after acute mucosal injury.Am J Physiol. 1988; 255: G62-G71
- Hyperoxaluria and calcium oxalate nephrolithiasis after jejunoileal bypass.Am J Clin Nutr. 1977; 30: 64-71
Article info
Publication history
Published online: February 07, 2011
Accepted:
November 24,
2010
Footnotes
Supported by NIH grant DK-77669 to RK.
Identification
Copyright
© 2011 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
