TY - JOUR
T1 - Nephrolithiasis After Bariatric Surgery for Obesity
AU - Lieske, John C.
AU - Kumar, Rajiv
AU - Collazo-Clavell, Maria L.
N1 - Funding Information:
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.
PY - 2008/3
Y1 - 2008/3
N2 - Surgical intervention has become an accepted therapeutic alternative for the patient with medically complicated obesity. Multiple investigators have reported significant and sustained weight loss after bariatric surgery that is associated with improvement of many weight-related medical comorbidities, and statistically significant decreased overall mortality for surgically treated as compared with medically treated subjects. Although the Roux-en-Y gastric bypass (RYGB) is considered an acceptably safe treatment, an increasing number of patients are being recognized with nephrolithiasis after this, the most common bariatric surgery currently performed. The main risk factor appears to be hyperoxaluria, although low urine volume and citrate concentrations may contribute. The incidence of these urinary risk factors among the total post-RYGB population is unknown, but may be more than previously suspected based on small pilot studies. The etiology of the hyperoxaluria is unknown, but may be related to subtle and seemingly subclinical fat malabsorption. Clearly, further study is needed, especially to define better treatment options than the standard advice for a low-fat, low-oxalate diet, and use of calcium as an oxalate binder.
AB - Surgical intervention has become an accepted therapeutic alternative for the patient with medically complicated obesity. Multiple investigators have reported significant and sustained weight loss after bariatric surgery that is associated with improvement of many weight-related medical comorbidities, and statistically significant decreased overall mortality for surgically treated as compared with medically treated subjects. Although the Roux-en-Y gastric bypass (RYGB) is considered an acceptably safe treatment, an increasing number of patients are being recognized with nephrolithiasis after this, the most common bariatric surgery currently performed. The main risk factor appears to be hyperoxaluria, although low urine volume and citrate concentrations may contribute. The incidence of these urinary risk factors among the total post-RYGB population is unknown, but may be more than previously suspected based on small pilot studies. The etiology of the hyperoxaluria is unknown, but may be related to subtle and seemingly subclinical fat malabsorption. Clearly, further study is needed, especially to define better treatment options than the standard advice for a low-fat, low-oxalate diet, and use of calcium as an oxalate binder.
KW - Bariatric surgery
KW - Roux-en-Y gastric bypass
KW - enteric hyperoxaluria
KW - nephrolithiasis
KW - obesity
KW - oxalate
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U2 - 10.1016/j.semnephrol.2008.01.009
DO - 10.1016/j.semnephrol.2008.01.009
M3 - Article
C2 - 18359397
AN - SCOPUS:40849126674
SN - 0270-9295
VL - 28
SP - 163
EP - 173
JO - Seminars in nephrology
JF - Seminars in nephrology
IS - 2
ER -