Clinical Investigation

Kidney International (1991) 39, 1249–1254; doi:10.1038/ki.1991.158

Pathogenesis of nephrolithiasis post-partial ileal bypass surgery: Case-control study

Chamberlain I Obialo, Ralph V Clayman, John P Matts, Laurie L Fitch, Henry Buchwald, Mary Gillis and Keith A Hruska and the POSCH Group1

Renal Division, Jewish Hospital, and Division of Urology, Washington University School of Medicine, St. Louis, Missouri; and Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA

Correspondence: Keith A Hruska MD, Renal Division, Jewish Hospital, Washington University School of Medicine, 216 South Kings-highway Blvd., St. Louis, Missouri 63110, USA.

1Members of the POSCH Group are listed in the Appendix.

Received 2 April 1990; Revised 11 January 1991; Accepted 11 January 1991.

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Abstract

Pathogenesis of nephrolithiasis post-partial ileal bypass surgery: Case control study. Between 1975 and 1983, 838 patients were randomized into the Program on the Surgical Control of Hyperlipidemias (POSCH) trial: 417 to standard medical care and 421 to partial ileal bypass (PIB) surgery. During the course of the trial, an increased incidence of kidney stone formation was found in the surgery group (4%/year) as compared to the control group (0.4%/year). A matched triplet case-control study was conducted to assess the possible causes for the increased incidence of kidney stones. Three groups were studied: PIB stone-formers (S); PIB non-stone formers (N); and non-PIB, non-stone formers in the control group (C). Initially, 162 patients (54 triplets) were selected. Ten percent of the patients declined to participate which resulted in a sample size of 146 patients. The PIB patients had statistically significant (P< 0.05) lower levels of serum vitamin D metabolites; lower urine volume, pH, citrate, magnesium, carbon dioxide, and sulfate, and higher urinary oxalate, ammonia and relative supersaturation for calcium oxalate and uric acid than the control patients. Although S and N had similar results, those S with no prior history of stones had a higher calcium oxalate supersaturation than similar N with a negative prior history of stones (P< 0.025). Based on these results, all PIB patients appear to be at risk for kidney stone formation. The combination of reduced urinary volume and calcium oxalate precipitation inhibitor substance with increased calcium oxalate relative supersaturation produced an increase in nephrolithiasis risk in the PIB groups.

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