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2014 ; 10
(4
): 734-42
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Kidney stone incidence and metabolic urinary changes after modern bariatric
surgery: review of clinical studies, experimental models, and prevention
strategies
#MMPMID24969092
Canales BK
; Hatch M
Surg Obes Relat Dis
2014[Jul]; 10
(4
): 734-42
PMID24969092
show ga
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.