Hyperoxaluria in kidney stone formers treated with modern bariatric surgery
Hyperoxaluria in kidney stone formers treated with modern bariatric surgery
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DOI：
10.1016/j.juro.2006.09.033
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发表时间：
2007-02-01
影响因子：
6.6
通讯作者：
Coe, Fredric L.
中科院分区：
文献类型：
--
作者：
Asplin, John R.;Coe, Fredric L.
目的：严重高草酸尿继发的肾结石和肾功能衰竭是空肠回肠转流术治疗肥胖症的并发症，导致该手术于1980年在美国停止。材料和方法：我们比较了132例接受减肥手术的肾结石患者的24小时尿化学研究，以及接受空肠回肠搭桥术的患者、常规肾结石患者和正常人的24小时尿化学研究。主要目的是确定接受减肥手术并患有肾结石的患者是否会出现高草酸尿，就像空肠回肠转流术所看到的那样。结果：接受现代减肥手术的患者调整后的平均尿草酸排泄量为每天83毫克，而常规肾结石患者和正常受试者的尿草酸排泄量分别为39毫克和34毫克(两组均为0.001)，但并不像空肠转流术患者(102毫克/天，P<；0.001)那么高。作为草酸钙结石形成的主要驱动力，接受减肥手术的肾结石患者的尿草酸钙过饱和度高于常规肾结石患者和正常人(P<；0.001)。结论：高草酸尿是肾结石患者减肥手术后最显著的尿液化学异常。这些患者中的许多人都有一定程度的高草酸尿，可能会导致肾衰竭。需要进一步的研究来确定这一问题在接受过减肥手术的患者中的患病率。
Purpose: Nephrolithiasis and renal failure secondary to severe hyperoxaluria were complications of jejunoileal bypass for obesity, leading to the discontinuation of this procedure in the United States in 1980. Bariatric procedures currently in use have not been adequately evaluated for this complication.Materials and Methods: We compared 24-hour urine chemistry studies of 132 patients with nephrolithiasis who had undergone bariatric surgery with the urine chemistry studies of patients who had undergone jejunoileal bypass, those with routine kidney stones and normal subjects. The primary aim was to determine if hyperoxaluria developed in patients who underwent bariatric surgery and had kidney stones as had been seen with jejunoileal bypass.Results: Patients who have undergone modern bariatric surgery had an adjusted mean urine oxalate excretion of 83 mg per day compared to 39 mg per day for routine kidney stone formers and 34 mg per day for normal subjects (p < 0.001 for both comparisons), but not quite as high as that found in patients treated with jejunoileal bypass (102 mg per day, p < 0.001). Urine supersaturation of calcium oxalate, the main driving force for calcium oxalate stone formation, was higher in patients treated with bariatric surgery compared to routine kidney stone formers and normal subjects (p < 0.001 for both comparisons).Conclusions: Hyperoxaluria is the most significant abnormality of urine chemistry studies in patients with kidney stones who have undergone bariatric surgery. Many of these patients have a degree of hyperoxaluria that could lead to kidney failure. Further studies are required to determine the prevalence of this problem in patients who have undergone bariatric surgery.