Hyperoxaluric nephrolithiasis is a complication of Roux-en-Y gastric bypass surgery
Hyperoxaluric nephrolithiasis is a complication of Roux-en-Y gastric bypass surgery
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DOI：
10.1038/sj.ki.5002194
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发表时间：
2007-07-01
影响因子：
19.6
通讯作者：
Lieske, J. C.
中科院分区：
文献类型：
--
作者：
Sinha, M. K.;Collazo-Clavell, M. L.;Lieske, J. C.
Roux-en-Y搭桥手术是目前美国对医学上复杂的肥胖进行的最常见的减肥手术。虽然这导致了显著和持续的体重减轻，但我们发现越来越多的患者在之后发生了肾结石。我们描述了在梅奥诊所-罗切斯特看到的60例患者在Roux-en-Y胃旁路手术(RYGB)后发展为肾结石，包括在梅奥·斯通诊所接受代谢评估的31名患者的子集。术前平均体重指数57 kg/m(2)，结石发生时平均减少20 kg/m(2)，术后平均2.2年。分析发现草酸钙结石19例，草酸钙/尿酸混合结石2例。即使在没有肾结石病史的患者中，高草酸尿也是一个流行因素，通常在手术后6个月以上出现。然而，由于尿量较少，术后不到6个月的患者草酸钙过饱和度也同样高。在接受这种搭桥手术的患者中进行的一个小范围随机抽样中，高草酸尿在术前是罕见的，但在术后12个月是常见的。我们得出结论，高草酸尿是RYGB手术潜在的并发症因素，表现为草酸钙结石的风险。
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/m(2) with a mean decrease of 20 kg/m(2) 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.