Original Article

Kidney International (2007) 72, 100–107; doi:10.1038/sj.ki.5002194; published online 21 March 2007

Hyperoxaluric nephrolithiasis is a complication of Roux-en-Y gastric bypass surgery

M K Sinha1, M L Collazo-Clavell2, A Rule3, D S Milliner3, W Nelson4, M G Sarr5, R Kumar2,3,6 and J C Lieske3,7

  1. 1Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  2. 2Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  3. 3Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  4. 4Mayo Medical School, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  5. 5Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  6. 6Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  7. 7Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA

Correspondence: JC Lieske, Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, Minnesota, 55905, USA. E-mail: Lieske.John@mayo.edu

Received 10 August 2006; Revised 13 January 2007; Accepted 23 January 2007; Published online 21 March 2007.

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Abstract

Roux-en-Y bypass surgery is the most common bariatric procedure currently performed in the United States for medically complicated obesity. Although this leads to a marked and sustained weight loss, we have identified an increasing number of patients with episodes of nephrolithiasis afterwards. We describe a case series of 60 patients seen at Mayo Clinic-Rochester that developed nephrolithiasis after Roux-en-Y gastric bypass (RYGB), including a subset of 31 patients who had undergone metabolic evaluation in the Mayo Stone Clinic. The mean body mass index of the patients before procedure was 57 kg/m2 with a mean decrease of 20 kg/m2 at the time of the stone event, which averaged 2.2 years post-procedure. When analyzed, calcium oxalate stones were found in 19 and mixed calcium oxalate/uric acid stones in two patients. Hyperoxaluria was a prevalent factor even in patients without a prior history of nephrolithiasis, and usually presented more than 6 months after the procedure. Calcium oxalate supersaturation, however, was equally high in patients less than 6 months post-procedure due to lower urine volumes. In a small random sampling of patients undergoing this bypass procedure, hyperoxaluria was rare preoperatively but common 12 months after surgery. We conclude that hyperoxaluria is a potential complicating factor of RYGB surgery manifested as a risk for calcium oxalate stones.

Keywords:

bariatric surgery, enteric hyperoxaluria, nephrolithiasis, obesity, oxalate, roux-en-Y gastric bypass

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