Enteric hyperoxaluria, nephrolithiasis, and oxalate nephropathy: potentially serious and unappreciated complications of Roux-en-Y gastric bypass.
Enteric hyperoxaluria, nephrolithiasis, and oxalate nephropathy: potentially serious and unappreciated complications of Roux-en-Y gastric bypass.
复制标题
DOI：
10.1016/j.soard.2005.07.002
复制
发表时间：
2005-09-01
期刊：
影响因子：
--
通讯作者：
Sarr, Michael G
中科院分区：
文献类型：
--
作者：
Nelson, Wayne K;Houghton, Scott G;Sarr, Michael G
背景：Roux-en-Y胃旁路术（RYGBP）后肠源性高尿症的存在和患病率均未被认识到。我们注意到草酸盐肾结石的发生率很高，甚至有2例患者术后发生草酸盐肾病。我们的目的是确定的发生率和影响肠道高尿酸后RYGBP.METHODS：回顾性分析所有患者在我们的机构诊断为草酸钙肾结石或草酸盐肾病后标准（n = 14）或远端（n = 9）RYGBP。平均术后随访55个月。结果：共23例患者（14名男性和9名女性;平均年龄45岁;平均术前体重指数55 kg/m2）在RYGBP后出现肠源性高尿症，定义为存在草酸盐肾病（n = 2）或草酸钙肾结石（n = 21）和24小时尿草酸盐排泄增加和/或或草酸钙过饱和。在RYGBP后29个月（范围2-85）平均体重减轻46 kg后，发现肠源性高尿症。2例患者发生肾衰竭，需要长期血液透析。在21例肾结石患者中，14例术前无肾结石病史，19例需要碎石术或其他干预。在23例患者中，20个测试有增加的草酸排泄，和14 15个测试有高尿草酸钙supersaturation.CONCLUSION：肠高尿症，肾结石，草酸盐肾病必须考虑与RYGBP的其他风险。应努力确定使患者易患高尿酸血症的因素。
BACKGROUND: Neither the presence nor prevalence of enteric hyperoxaluria has been recognized after Roux-en-Y gastric bypass (RYGBP). We have noted a high rate of oxalate nephrolithiasis and even 2 patients with oxalate nephropathy in this patient population postoperatively. Our aim was to determine the frequency of the occurrence and effects of enteric hyperoxaluria after RYGBP.METHODS: Retrospective review of all patients at our institution diagnosed with calcium oxalate nephrolithiasis or oxalate nephropathy after standard (n = 14) or distal (n = 9) RYGBP. The mean postoperative follow-up was 55 months.RESULTS: A total of 23 patients (14 men and 9 women; mean age 45 years; mean preoperative body mass index 55 kg/m(2)) developed enteric hyperoxaluria after RYGBP, defined by the presence of oxalate nephropathy (n = 2) or calcium oxalate nephrolithiasis (n = 21) and increased 24-hour excretion of urinary oxalate and/or calcium oxalate supersaturation. Enteric hyperoxaluria was recognized after a mean weight loss of 46 kg at 29 months (range 2-85) after RYGBP. Two patients developed renal failure and required chronic hemodialysis. Of the 21 patients with nephrolithiasis, 14 had no history of nephrolithiasis preoperatively, and 19 of 21 required lithotripsy or other intervention. Of the 23 patients, 20 tested had increased oxalate excretion, and 14 of 15 tested had high urine calcium oxalate supersaturation.CONCLUSION: Enteric hyperoxaluria, nephrolithiasis, and oxalate nephropathy must be considered with the other risks of RYGBP. Efforts should be made to identify factors that predispose patients to developing hyperoxaluria.