Kidney stone incidence and metabolic urinary changes after modern bariatric surgery: review of clinical studies, experimental models, and prevention strategies.
Kidney stone incidence and metabolic urinary changes after modern bariatric surgery: review of clinical studies, experimental models, and prevention strategies.
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DOI：
10.1016/j.soard.2014.03.026
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发表时间：
2014-07
影响因子：
3.1
通讯作者：
Hatch, Marguerite
中科院分区：
文献类型：
--
作者：
Canales, Benjamin K.;Hatch, Marguerite
关键词：
减肥手术与代谢性肾结石风险增加和术后结石形成有关。对 2005 年 1 月至 2013 年 11 月期间发表的文章进行的 MEDLINE 搜索发现了 24 项相关研究，其中包括 683 名具有 24 小时尿液特征的肥胖患者、6,777 名患有肾结石发病率的肥胖患者以及 7,089 名未形成结石的对照组。在所有审查的手术中，只有 Roux-en-Y 胃绕道手术 (RYGB) 与术后肾结石的形成有关，使非结石患者的结石发生率增加两倍 (8.5%)，使有结石病史的患者增加四倍 (16.7%)。来自 RYGB 前后的 7 项研究（n = 277 名患者）的高质量证据确定了 RYGB 后以下尿路结石危险因素：尿量减少 30%（尿晶体饱和的主要驱动因素）、尿柠檬酸盐减少 40%（一种有效的结石抑制剂）和尿草酸盐增加 50%（结石促进剂）。在此基础上，总结了 RYGB 后降低草酸钙结石风险的策略。此外，最近的实验性 RYGB 研究进行了评估，以深入了解草酸盐处理的病理生理学，并回顾了肠道阴离子（草酸盐）转运的文献。最后，作为治疗高草酸尿症的潜在益生菌疗法，我们实验室的主要数据显示，四只实验性 RYGB 动物在定植福米吉斯草酸杆菌（一种使用草酸盐作为能源的非致病性肠道共生菌）后，尿草酸盐水平降低了 70%。总体而言，减肥手术后的尿液特征和肾结石风险似乎可以通过饮食调整、适当的补充和生活方式的改变来改变。对于对饮食草酸盐限制和钙结合具有抵抗力的高草酸尿症，需要精心设计的人体研究来确定降低尿草酸盐的其他方法，例如草酸杆菌定植或经验性吡哆醇治疗。还需要进一步的研究来确定该人群中结石预防策略（例如补充柠檬酸盐和水合）的耐受性和依从性。
Bariatric surgery has been associated with increased metabolic kidney stone risk and post-operative stone formation. A MEDLINE search, performed for articles published between January 2005 and November 2013, identified 24 pertinent studies containing 683 bariatric patients with 24-hour urine profiles, 6,777 bariatric patients with kidney stone incidence, and 7,089 non-stone forming controls. Of all procedures reviewed, only Roux-en-Y gastric bypass (RYGB) was linked to post-operative kidney stone development, increasing stone incidence two-fold in non-stone formers (8.5%) and four-fold in patients with previous stone history (16.7%). High quality evidence from 7 studies (n=277 patients) before and after RYGB identified the following post-RYGB urinary lithogenic risk factors: 30% reduction in urine volume (the main driver of urinary crystal saturation), 40% reduction in urinary citrate (a potent stone inhibitor), and 50% increase in urinary oxalate (a stone promotor). Based on this, a summary of strategies to reduce calcium oxalate stone risk following RYGB is provided. Furthermore, recent experimental RYGB studies are assessed for insights into the pathophysiology of oxalate handling, and the literature in gut anion (oxalate) transport is reviewed. Finally, as a potential probiotic therapy for hyperoxaluria, primary data from our laboratory is presented, demonstrating a 70% reduction in urinary oxalate levels in four experimental RYGB animals after colonization with Oxalobacter formigines, a non-pathogenic gut commensal that uses oxalate as an energy source. Overall, urine profiles and kidney stone risk following bariatric surgery appear modifiable by dietary adjustments, appropriate supplementation, and lifestyle changes. For hyperoxaluria resistant to dietary oxalate restriction and calcium binding, well-designed human investigations are needed to identify additional means of lowering urinary oxalate, such as Oxalobacter colonization or empiric pyridoxine therapy. Further investigations are also needed to determine tolerability and compliance of stone prevention strategies, such as citrate supplementation and hydration, in this population.
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影响因子：
6.6
作者：
Canales, Benjamin K.;Ellen, Joseph;Hatch, Marguerite
通讯作者：
Hatch, Marguerite
DOI：
10.1152/ajpgi.00434.2010
发表时间：
2011-03-01
影响因子：
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通讯作者：
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影响因子：
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作者：
Hoppe, Bernd;Groothoff, Jaap W.;Milliner, Dawn
通讯作者：
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