Roux-en-Y gastric bypass is associated with early increased risk factors for development of calcium oxalate nephrolithiasis
Roux-en-Y gastric bypass is associated with early increased risk factors for development of calcium oxalate nephrolithiasis
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DOI：
10.1016/j.jamcollsurg.2008.01.015
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发表时间：
2008-06-01
影响因子：
5.2
通讯作者：
Monga, Manoj
中科院分区：
文献类型：
--
作者：
Duffey, Branden G.;Pedro, Renato N.;Monga, Manoj
背景技术背景：接受空回肠旁路术（JIB）治疗的肥胖患者发生高尿酸血症、肾结石和草酸盐肾病的风险显著增加。空回肠旁路术已被放弃并被其他选择所取代，包括Roux-en-Y胃旁路术（RYGB）。RYGB后尿结石危险因素的变化目前尚不清楚。我们的目的是确定RYGB是否与通过增加尿草酸盐排泄和草酸钙相对过饱和而增加的草酸钙结石形成风险有关。研究设计：一项前瞻性纵向队列研究，纳入了24名病态肥胖成人（9名男性和15名女性），这些人是从一所大学的减肥手术诊所招募的，计划在2005年12月至2007年4月期间接受RYGB。分别于术前7 d及术后90 d收集患者24 h尿液进行分析。主要结果是从基线到RYGB后3个月24小时尿草酸排泄量和草酸钙相对过饱和度的变化。结果：与基线相比，接受RYGB的患者尿草酸排泄量显著增加（31 +/-10 mg/d vs 41 +/-18 mg/d; p = 0.026）和草酸钙相对过饱和度（1.73 +/-0.81 vs 3.47 +/-2.59; p = 0.030）。6例患者（25%）发生原发性高尿酸血症。有没有术前患者的特点预测的发展从头高尿酸或每日草酸excretions.CONCLUSIONS的变化幅度：这项前瞻性研究表明，RYGB与早期增加尿草酸排泄和相对过饱和的草酸钙比以前报道。需要进一步的研究来确定长期的RYGB后尿草酸排泄的变化，并确定可能有高尿症发生风险的患者。
BACKGROUND: Patients treated for obesity with jejunoileal bypass (JIB) experienced a marked increased risk of hyperoxaluria, nephrolithiasis, and oxalate nephropathy developing. jejunoileal bypass has been abandoned and replaced with other options, including Roux-en-Y gastric bypass (RYGB). Changes in urinary lithogenic risk factors after RYGB are currently unknown. Our purpose was to determine whether RYGB is associated with elevated risk of developing calcium oxalate stone formation through increased urinary oxalate excretion and relative supersaturation of calcium oxalate.STUDY DESIGN: A prospective longitudinal cohort study of 24 morbidly obese adults (9 men and 15 women) recruited from a university-based bariatric surgery clinic scheduled to undergo RYGB between December 2005 and April 2007. Patients provided 24-hour urine collections for analysis 7 days before and 90 days after operation. Primary outcomes were changes in 24-hour urinary oxalate excretion and relative supersaturation of calcium oxalate from baseline to 3 months post-RYGB.RESULTS: Compared with their baseline, patients undergoing RYGB had significantly increased urinary oxalate excretion (31 +/- 10 mg/d versus 41 +/- 18 mg/d; p = 0.026) and relative supersaturation of calcium oxalate (1.73 +/- 0.81 versus 3.47 +/- 2.59; p = 0.030) 3 months post-RYGB. Six patients (25%) developed de novo hyperoxaluria. There were no preoperative patient characteristics predictive of development of de novo hyperoxaluria or the magnitude of change of daily oxalate excretion.CONCLUSIONS: This prospective study indicates that RYGB is associated with an earlier increase in urinary oxalate excretion and relative supersaturation of calcium oxalate than previously reported. Additional studies are needed to determine longterm post-RYGB changes in urinary oxalate excretion and identify patients that might be at risk for hyperoxaluria developing.