1
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Li J, Huang S, Liu S, Liao X, Yan S, Liu Q. SLC26 family: a new insight for kidney stone disease. Front Physiol 2023; 14:1118342. [PMID: 37304821 PMCID: PMC10247987 DOI: 10.3389/fphys.2023.1118342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/18/2023] [Indexed: 06/13/2023] Open
Abstract
The solute-linked carrier 26 (SLC26) protein family is comprised of multifunctional transporters of substrates that include oxalate, sulphate, and chloride. Disorders of oxalate homeostasis cause hyperoxalemia and hyperoxaluria, leading to urinary calcium oxalate precipitation and urolithogenesis. SLC26 proteins are aberrantly expressed during kidney stone formation, and consequently may present therapeutic targets. SLC26 protein inhibitors are in preclinical development. In this review, we integrate the findings of recent reports with clinical data to highlight the role of SLC26 proteins in oxalate metabolism during urolithogenesis, and discuss limitations of current studies and potential directions for future research.
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Affiliation(s)
- Jialin Li
- The First Clinical College, Gannan Medical University, Ganzhou, Jiangxi, China
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Sigen Huang
- The First Clinical College, Gannan Medical University, Ganzhou, Jiangxi, China
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Shengyin Liu
- The First Clinical College, Gannan Medical University, Ganzhou, Jiangxi, China
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Xinzhi Liao
- The First Clinical College, Gannan Medical University, Ganzhou, Jiangxi, China
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Sheng Yan
- The First Clinical College, Gannan Medical University, Ganzhou, Jiangxi, China
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Quanliang Liu
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
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2
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Kafi F, Mortazavi M, Pouramini A, Dolatkhah S, Kaleidari B, Taheri D. Secondary oxalate nephropathy and impact of high-dose vitamin C intake for COVID-19 prevention on a patient with Roux-en-Y gastric bypass: A case report. Clin Case Rep 2023; 11:e7020. [PMID: 36911630 PMCID: PMC9992142 DOI: 10.1002/ccr3.7020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/04/2023] [Accepted: 02/15/2023] [Indexed: 03/11/2023] Open
Abstract
The current study is important in informing clinicians about the possibility of concurrent oxalate nephropathy caused by Roux-en-Y gastric bypass, high oxalate materials, and high-dose vitamin C intake for COVID-19 prevention.
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Affiliation(s)
- Fatemeh Kafi
- Department of Pathology, Isfahan Kidney Diseases Research Center Isfahan University of Medical Sciences Isfahan Iran.,Urology Research Center Tehran University of Medical Sciences Tehran Iran
| | - Mojgan Mortazavi
- Isfahan Kidney Diseases Research Center Isfahan University of Medical Sciences Isfahan Iran
| | - Alireza Pouramini
- Department of Pathology, Isfahan Kidney Diseases Research Center Isfahan University of Medical Sciences Isfahan Iran.,Urology Research Center Tehran University of Medical Sciences Tehran Iran
| | | | - Behrouz Kaleidari
- Alzahra Hospital Isfahan University of Medical Sciences Isfahan Iran
| | - Diana Taheri
- Department of Pathology, Isfahan Kidney Diseases Research Center Isfahan University of Medical Sciences Isfahan Iran.,Urology Research Center Tehran University of Medical Sciences Tehran Iran
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3
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Campschroer T, Van Balken MR, Deden LN, Hazebroek EJ, De Boer H. Effect of preoperative metabolic profiling to reduce the risk of kidney stones after bariatric surgery in patients with a history of stone formation. Surg Obes Relat Dis 2022; 19:633-639. [PMID: 36609096 DOI: 10.1016/j.soard.2022.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/20/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is associated with an increased risk of kidney stone formation. This is not observed after sleeve gastrectomy (SG). OBJECTIVES Aim of this study was to assess whether preoperative metabolic profiling is helpful in selecting the most optimal bariatric procedure for patients with a kidney stone history. SETTING General hospital, the Netherlands. METHODS Patients with a kidney stone history and in the run up to bariatric surgery were screened with non-contrast abdominal computed tomography (CT), serum profiling, and 24-hour urine analysis. Those with stones on radiologic imaging and/or high preoperative urinary oxalate were advised to undergo SG instead of RYGB. Pre- and postoperative urine and serum profile differences between both groups were evaluated retrospectively. RESULTS Postoperatively, RYGB (N = 28, M:F = 8:20) was associated with a 23.5% reduction in urinary volume, a 85% increase in urinary oxalate excretion with a 230% increase in calcium oxalate (CaOx) supersaturation and a 62% decrease in urinary citrate. Although SG (N = 30, M:F = 12:18) was also associated with a reduction in urinary volume, it had no adverse effects on urinary oxalate and citrate excretion, nor on calcium oxalate supersaturation (CaOx-SS). Both RYGB and SG showed favorable effects on postoperative sodium, calcium, uric acid, and phosphate excretion. CONCLUSIONS This study indicates that preoperative metabolic profiling is important to select the optimal bariatric procedure in patients with an a priori increased risk of kidney stone development. These patients should be strongly encouraged to undergo SG instead of RYGB to prevent progressive or recurrent kidney stone disease.
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Affiliation(s)
| | | | - Laura N Deden
- Bariatric Surgery Department, Rijnstate Hospital, Arnhem, the Netherlands
| | - Eric J Hazebroek
- Bariatric Surgery Department, Rijnstate Hospital, Arnhem, the Netherlands
| | - Hans De Boer
- Internal Medicine Department, Rijnstate Hospital, Arnhem, the Netherlands
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4
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Gadiyar N, Geraghty RM, Premakumar Y, Somani BK. Changes in Urine Composition and Risk of Kidney Stone Disease Following Bariatric Surgery: A Systematic Review over Last 2 Decades. Curr Urol Rep 2022; 23:279-295. [PMID: 36417046 DOI: 10.1007/s11934-022-01119-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The association of kidney stone disease (KSD) and gastrointestinal (GI) surgery has been well established. With a rising obesity crisis, we wanted to see the correlation of urinary composition in patients undergoing bariatric surgery and their risk of KSD. The objective of this paper is to perform a systematic review and meta-analysis of literature to evaluate the changes in urinary composition and risk of KSD following bariatric surgery. RECENT FINDINGS A total of seven studies (2498 patients) underwent bariatric surgery with a mean age of 46.7 years and a male:female ratio of 1:3. The most popular bariatric surgery was the Roux-en-Y procedure. Meta-analysis of the studies showed that significant decrease in urinary calcium, citrate, and urate, and increase in urinary oxalate. There was also a nonsignificant volume reduction in the post-operative cohort. The decrease in urinary citrate and increase in urinary oxalate are both predisposing factors of stone formation. There is strong evidence that bariatric surgery results in significant changes in urine composition in keeping with the increased risk of developing KSD. This identifies useful therapeutic targets in the prophylactic management of patients who have undergone bariatric surgery.
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Affiliation(s)
- Neha Gadiyar
- General Surgery, Guys and St Thomas', London, UK
| | | | | | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK.
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5
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Wang J, Wang W, Wang H, Tuo B. Physiological and Pathological Functions of SLC26A6. Front Med (Lausanne) 2021; 7:618256. [PMID: 33553213 PMCID: PMC7859274 DOI: 10.3389/fmed.2020.618256] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/30/2020] [Indexed: 12/26/2022] Open
Abstract
Solute Carrier Family 26 (SLC26) is a conserved anion transporter family with 10 members in human (SLC26A1-A11, A10 being a pseudogene). All SLC26 genes except for SLC26A5 (prestin) are versatile anion exchangers with notable ability to transport a variety of anions. SLC26A6 has the most extensive exchange functions in the SLC26 family and is widely expressed in various organs and tissues of mammals. SLC26A6 has some special properties that make it play a particularly important role in ion homeostasis and acid-base balance. In the past few years, the function of SLC26A6 in the diseases has received increasing attention. SLC26A6 not only participates in the development of intestinal and pancreatic diseases but also serves a significant role in mediating nephrolithiasis, fetal skeletal dysplasia and arrhythmia. This review aims to explore the role of SLC26A6 in physiology and pathophysiology of relative mammalian organs to guide in-depth studies about related diseases of human.
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Affiliation(s)
- Juan Wang
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Wenkang Wang
- Department of Critical Care Medicine of the Third Affiliated Hospital (The First People's Hospital of Zunyi City), Zunyi Medical University, Zunyi, China
| | - Hui Wang
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Biguang Tuo
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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6
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Uy M, Di Lena R, Hoogenes J, Alharbi B, Gmora S, Shayegan B, Matsumoto ED. Bariatric Surgery in Patients with a History of Nephrolithiasis: 24-h Urine Profiles and Radiographic Changes After Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy. Obes Surg 2021; 31:1673-1679. [PMID: 33387265 DOI: 10.1007/s11695-020-05178-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/08/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND To evaluate the differences in 24-h urine profiles, radiographic imaging, and stone events post-Roux-en-Y gastric bypass versus sleeve gastrectomy in patients with a history of nephrolithiasis. METHODS A retrospective review was conducted on 102 patients with a history of nephrolithiasis who then underwent bariatric surgery at our tertiary academic center. Computed tomography imaging and 24-h urine profile values were performed pre-operatively and at 1-year follow-up. RESULTS A total of 60 patients underwent Roux-en-Y gastric bypass and 42 had sleeve gastrectomy. The Roux-en-Y gastric bypass group had significant increases in oxalate and decreases in citrate (p = 0.009 and 0.003, respectively), while the sleeve gastrectomy group had decreases in oxalate and stable citrate (p = 0.013 and 0.906, respectively). Roux-en-Y gastric bypass was the only significant predictor of post-operative hyperoxaluria (OR 7.1 [95% CI 2.3-21.3], p = 0.001). Radiographically, 38.3% of the Roux-en-Y gastric bypass group and 26.2% of the sleeve gastrectomy group had an increase in stone burden, and post-operative stone procedure rate was 10.0% and 7.1%, respectively. CONCLUSIONS At 1-year post-bariatric surgery, patients who underwent Roux-en-Y gastric bypass had exacerbated lithogenic urinary profiles, while those in sleeve gastrectomy patients improved. Although not statistically significant, stone burden increase and stone procedure rate were higher post-Roux-en-Y gastric bypass and will likely worsen at a longer follow-up due to the group's lithogenic 24-h urine profiles. These findings support pre-bariatric counseling and urinary monitoring in patients with a history of kidney stones who undergo RYGB, with a multi-disciplinary approach between urologists and general surgeons.
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Affiliation(s)
- Michael Uy
- Division of Urology, Department of Surgery, McMaster University, Hamilton, Canada
| | - Richard Di Lena
- Division of Urology, Department of Surgery, McMaster University, Hamilton, Canada
| | - Jen Hoogenes
- Division of Urology, Department of Surgery, McMaster University, Hamilton, Canada.,St. Joseph's Healthcare Hamilton, McMaster Institute of Urology, Hamilton, Canada
| | - Badr Alharbi
- Department of Surgery, College of Medicine, Qassim University, Buraydah, Saudi Arabia
| | - Scott Gmora
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - Bobby Shayegan
- Division of Urology, Department of Surgery, McMaster University, Hamilton, Canada.,St. Joseph's Healthcare Hamilton, McMaster Institute of Urology, Hamilton, Canada
| | - Edward D Matsumoto
- Division of Urology, Department of Surgery, McMaster University, Hamilton, Canada. .,St. Joseph's Healthcare Hamilton, McMaster Institute of Urology, Hamilton, Canada.
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7
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Prochaska M, Worcester E. Risk Factors for Kidney Stone Formation following Bariatric Surgery. ACTA ACUST UNITED AC 2020; 1:1456-1461. [PMID: 34085046 DOI: 10.34067/kid.0004982020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Kidney stones are painful, common, and increasing in incidence. Obesity and bariatric surgery rates are also on the rise in the United States. Although bariatric surgery is associated with improvements in metabolic outcomes, malabsorptive bariatric surgery procedures are also associated with increased risk of kidney stones. Restrictive bariatric surgeries have not been associated with kidney-stone risk. Higher risk of kidney stones after malabsorptive procedures is associated with postsurgical changes in urine composition, including high urine oxalate, low urine citrate, and low urine volume. Certain dietary recommendations after surgery may help mitigate these urine changes and reduce risk of kidney stones. Understanding risk of kidney stones after surgery is essential to improving patient outcomes after bariatric surgery.
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Affiliation(s)
- Megan Prochaska
- Section of Nephrology, University of Chicago, Chicago, Illinois
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8
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The Short-Term Renal Effects of Bariatric Surgery: A Comparative Study Between Sleeve Gastrectomy and One Anastomosis Gastric Bypass Operations Among Egyptian Patients With Severe Obesity. Obes Surg 2020; 30:4494-4504. [PMID: 32700183 DOI: 10.1007/s11695-020-04841-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/30/2020] [Accepted: 07/06/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Obesity is a major health problem with many renal sequelae. Bariatric surgery (BS) has become the treatment of choice for severe obesity. This study was conducted to assess the short-term renal effects of BS and to compare such effects between two distinct forms of BS. MATERIALS AND METHODS A single-center non-randomized prospective observational study was conducted on 57 patients with severe obesity. Two distinct forms of BS have been performed; laparoscopic sleeve gastrectomy (LSG) and laparoscopic one anastomosis gastric bypass (OAGB). Anthropometric measurements, 24-h urinary creatinine clearance (CLCr), protein and oxalate excretion, and abdominal fat tissue analysis by computerized tomography were performed prior to surgery and 6 months later. RESULTS LSG and OAGB were performed in 47 and 10 participants, respectively. BS resulted in pronounced reduction of body mass index (- 27.1% ± 7.11), with no substantial weight loss discrepancy between LSG and OAGB. The median percent change in 24-h urinary CLCr and protein and oxalate excretion were - 35.7, - 42.2, and - 5.8, respectively. The median (IQR) percent change of urinary oxalate excretion was - 11.1 (- 22.6, - 1.4) and 113.08 (82.5, 179.7) for LSG and OAGB, respectively (p < 0.001). The subcutaneous abdominal fat surface area has been found to be the significant predictor of the persistence of glomerular hyperfiltration after BS. CONCLUSION Both LSG and OAGB can alleviate many of the obesity-related pathological renal changes. However, postoperative hyperoxaluria remains a serious issue particularly in OAGB. Detailed radiological abdominal fat tissue analysis by CT may aid in predicting the renal outcome following BS.
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9
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Ormanji MS, Rodrigues FG, Heilberg IP. Dietary Recommendations for Bariatric Patients to Prevent Kidney Stone Formation. Nutrients 2020; 12:nu12051442. [PMID: 32429374 PMCID: PMC7284744 DOI: 10.3390/nu12051442] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/09/2020] [Accepted: 05/13/2020] [Indexed: 12/12/2022] Open
Abstract
Bariatric surgery (BS) is one of the most common and efficient surgical procedures for sustained weight loss but is associated with long-term complications such as nutritional deficiencies, biliary lithiasis, disturbances in bone and mineral metabolism and an increased risk of nephrolithiasis, attributed to urinary metabolic changes resultant from low urinary volume, hypocitraturia and hyperoxaluria. The underlying mechanisms responsible for hyperoxaluria, the most common among all metabolic disturbances, may comprise increased intestinal oxalate absorption consequent to decreased calcium intake or increased dietary oxalate, changes in the gut microbiota, fat malabsorption and altered intestinal oxalate transport. In the current review, the authors present a mechanistic overview of changes found after BS and propose dietary recommendations to prevent the risk of urinary stone formation, focusing on the role of dietary oxalate, calcium, citrate, potassium, protein, fat, sodium, probiotics, vitamins D, C, B6 and the consumption of fluids.
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Affiliation(s)
- Milene S. Ormanji
- Nephrology Division, Universidade Federal de São Paulo, São Paulo 04023-062, Brazil; (M.S.O.); (F.G.R.)
| | - Fernanda G. Rodrigues
- Nephrology Division, Universidade Federal de São Paulo, São Paulo 04023-062, Brazil; (M.S.O.); (F.G.R.)
- Department of Nutrition, Universidade Federal de São Paulo, São Paulo 04023-062, Brazil
| | - Ita P. Heilberg
- Nephrology Division, Universidade Federal de São Paulo, São Paulo 04023-062, Brazil; (M.S.O.); (F.G.R.)
- Department of Nutrition, Universidade Federal de São Paulo, São Paulo 04023-062, Brazil
- Correspondence: ; Tel.: +55-(11)-5576-4848 (ext. 2465)
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Damaskos C, Litos A, Dimitroulis D, Antoniou EA, Mantas D, Kontzoglou K, Garmpis N. Cardiovascular Effects of Metabolic Surgery on Type 2 Diabetes. Curr Cardiol Rev 2020; 16:275-284. [PMID: 32077829 PMCID: PMC7903510 DOI: 10.2174/1573403x16666200220120226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 11/29/2019] [Accepted: 12/18/2019] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Cardiovascular, together with renal disease, claims a significant proportion of morbidity and mortality in association with type 2 diabetes mellitus (T2DM) and obesity. To improve the long-term renal and cardiovascular outcome, there is the incorporation of bariatric surgery (BS), which seems to be a pivotal intervention. Areas Explored: Cohort studies and randomized controlled trial (RCT) research of BS among patients with T2DM, were conducted by screening, and then information on renal effects and the cardiovascular outcome was gathered. Metabolic surgery (MS) and BS reduce both mortality and the risk of cardiovascular disorder, chronic kidney diseases and albuminuria. MS refers to a surgical approach, the primary intent of which is the control of metabolic alterations/hyperglycemia in contrast to BS which is a mere weight-reduction therapy. Patients suffering from poor glycaemic control and other macro and micro-vascular diseases will benefit from a surgical approach. The approach implicates hypertension glomerular remission, gut microbiota shift, reduced renal inflammation and fewer instances of chronic cardiac remodelling. CONCLUSION MS is beneficial where the main aim is to attain significant and long-lasting weight loss results. The RCTs have depicted the superiority which surgical mechanisms hold over medically- based therapy, for enhancing glycaemic control, and achieving remission of diabetes. This type of surgery improves life quality, reduces incidences of other obesity and diabetes related diseases like microvascular disases, sleep apnea, fatal disorder, and fatty liver disease.
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Affiliation(s)
- Christos Damaskos
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Litos
- Psychiatric Department, General Hospital of Athens G. Gennimatas, Athens, Greece
| | - Dimitrios Dimitroulis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathios A Antoniou
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Mantas
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Kontzoglou
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Garmpis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Arvans D, Alshaikh A, Bashir M, Weber C, Hassan H. Activation of the PKA signaling pathway stimulates oxalate transport by human intestinal Caco2-BBE cells. Am J Physiol Cell Physiol 2020; 318:C372-C379. [PMID: 31825656 PMCID: PMC7052606 DOI: 10.1152/ajpcell.00135.2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 12/04/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023]
Abstract
Most kidney stones are composed of calcium oxalate, and small increases in urine oxalate enhance the stone risk. The mammalian intestine plays a crucial role in oxalate homeostasis, and we had recently reported that Oxalobacter-derived factors stimulate oxalate transport by human intestinal Caco2-BBE (C2) cells through PKA activation. We therefore evaluated whether intestinal oxalate transport is directly regulated by activation of the PKA signaling pathway. To this end, PKA was activated with forskolin and IBMX (F/I). F/I significantly stimulated (3.7-fold) [14C]oxalate transport by C2 cells [≥49% of which is mediated by the oxalate transporter SLC26A6 (A6)], an effect completely blocked by the PKA inhibitor H89, indicating that it is PKA dependent. PKA stimulation of intestinal oxalate transport is not cell line specific, since F/I similarly stimulated oxalate transport by the human intestinal T84 cells. F/I significantly increased (2.5-fold) A6 surface protein expression by use of immunocytochemistry. Assessing [14C]oxalate transport as a function of increasing [14C]oxalate concentration in the flux medium showed that the observed stimulation is due to a F/I-induced increase (1.8-fold) in Vmax and reduction (2-fold) in Km. siRNA knockdown studies showed that significant components of the observed stimulation are mediated by A6 and SLC26A2 (A2). Besides enhancing A6 surface protein expression, it is also possible that the observed stimulation is due to PKA-induced enhanced A6 and/or A2 transport activity in view of the reduced Km. We conclude that PKA activation positively regulates oxalate transport by intestinal epithelial cells and that PKA agonists might therapeutically impact hyperoxalemia, hyperoxaluria, and related kidney stones.
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Affiliation(s)
- Donna Arvans
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Altayeb Alshaikh
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Mohamed Bashir
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Christopher Weber
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Hatim Hassan
- Department of Medicine, The University of Chicago, Chicago, Illinois
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12
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Bilha SC, Nistor I, Nedelcu A, Kanbay M, Scripcariu V, Timofte D, Siriopol D, Covic A. The Effects of Bariatric Surgery on Renal Outcomes: a Systematic Review and Meta-analysis. Obes Surg 2019; 28:3815-3833. [PMID: 30054877 DOI: 10.1007/s11695-018-3416-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND/OBJECTIVE Although promising, data regarding the renal impact and safety of bariatric surgery (BS) are insufficient. We aimed at investigating the benefits and harms of BS for weight loss on kidney function. METHODS A systematic review and meta-analysis of observational studies reporting data about the impact of BS (any techniques) on serum/plasma creatinine, creatinine clearance, glomerular filtration rate (GFR), proteinuria, nephrolithiasis, and need for renal replacement therapy (RRT)) was performed. Obese adults (non-chronic kidney disease (CKD), CKD or transplanted patients) that underwent BS for weight loss were included. After searching MEDLINE (inception to August 2017), the Cochrane Library (Issue 10-12, October 2017), and the websiteclinicaltrials.gov (August 2017), data were extracted and summarized using a random-effects model. RESULTS The final analysis included 23 cohort studies, comprising 3015 participants. Compared with renal function before treatment, BS significantly decreased serum creatinine level (mean difference (MD), - 0.08 mg dl-1; 95% confidence interval (CI), - 0.10 to - 0.06); p < 0.001) and proteinuria (MD, - 0.04 g 24 h-1; 95% CI, - 0.06 to - 0.02; p < 0.001) in the overall group. GFR significantly improved 6 months or more after BS both in the hyperfiltration and CKD subgroups. Renal function also tended to improve in renal transplant patients. Data on nephrolithiasis and the need for RRT were scarce or not reported. CONCLUSIONS BS apparently has positive effects on kidney function and tends to normalize GFR across different categories of renal impairment (hyperfiltration and CKD patients).
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Affiliation(s)
- Stefana Catalina Bilha
- Nephrology Department, "Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.,Endocrinology Clinic, "St. Spiridon" Hospital, Iasi, Romania
| | - Ionut Nistor
- Nephrology Department, "Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.,Nephrology Clinic, Dialysis and Renal Transplant Centre, "C. I. Parhon" University Hospital, Iasi, Romania.,European Renal Best Practice (ERBP), Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Alina Nedelcu
- Nephrology Department, "Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey
| | - Viorel Scripcariu
- Department of General Surgery, Regional Institute of Oncology, Iasi, Romania.,General Surgery Department, "Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Daniel Timofte
- General Surgery Department, "Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania. .,Department of General Surgery, "St. Spiridon Hospital, Iasi, Romania. .,Surgery Department, "St. Spiridon" Hospital, "Grigore T. Popa University of Medicine and Pharmacy, No. 16 University Street, 700115, Iasi, Romania.
| | - Dimitrie Siriopol
- Nephrology Department, "Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.,Nephrology Clinic, Dialysis and Renal Transplant Centre, "C. I. Parhon" University Hospital, Iasi, Romania
| | - Adrian Covic
- Nephrology Department, "Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.,Nephrology Clinic, Dialysis and Renal Transplant Centre, "C. I. Parhon" University Hospital, Iasi, Romania
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13
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Nephrolithiasis after bariatric surgery: A comparison of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy. Am J Surg 2019; 219:952-957. [PMID: 31564408 DOI: 10.1016/j.amjsurg.2019.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/26/2019] [Accepted: 09/10/2019] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Laparoscopic Roux-en-Y gastric bypass (LRYGB) is known to increase risk for calcium oxalate nephrolithiasis due to hyperoxaluria; however, nephrolithiasis rates after laparoscopic sleeve gastrectomy (LSG) are not well described. Our objective was to determine the rate of nephrolithiasis after LRYGB versus LSG. METHODS The electronic medical records of patients who underwent LRYGB or LSG between 2001 and 2017 were retrospectively reviewed. RESULTS 1,802 patients were included. Postoperative nephrolithiasis was observed in 133 (7.4%) patients, overall, and 8.12% of LRYGB (122/1503) vs. 3.68% of LSG (11/299) patients (P < 0.001). Mean time to stone formation was 2.97 ± 2.96 years. Patients with a history of UTI (OR = 2.12, 95%CI 1.41-3.18; P < 0.001) or nephrolithiasis (OR = 8.81, 95%CI 4.93-15.72; P < 0.001) were more likely to have postoperative nephrolithiasis. CONCLUSION The overall incidence of symptomatic nephrolithiasis after bariatric surgery was 7.4%. Patients who underwent LRYGB had a higher incidence of nephrolithiasis versus LSG. Patients with a history of stones had the highest risk of postoperative nephrolithiasis.
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Snijders MLH, Hesselink DA, Clahsen-van Groningen MC, Roodnat JI. Oxalate deposition in renal allograft biopsies within 3 months after transplantation is associated with allograft dysfunction. PLoS One 2019; 14:e0214940. [PMID: 30990835 PMCID: PMC6467373 DOI: 10.1371/journal.pone.0214940] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/22/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Calcium oxalate (CaOx) deposition in the kidney may lead to loss of native renal function but little is known about the prevalence and role of CaOx deposition in transplanted kidneys. METHODS In patients transplanted in 2014 and 2015, all for-cause renal allograft biopsies obtained within 3 months post-transplantation were retrospectively investigated for CaOx deposition. Additionally, all preimplantation renal biopsies obtained in 2000 and 2001 were studied. RESULTS In 2014 and 2015, 388 patients were transplanted, of whom 149 had at least one for-cause renal biopsy. Twenty-six (17%) patients had CaOx deposition. In the population with CaOx deposition: Patients had significantly more often been treated with dialysis before transplantation (89 vs. 64%; p = 0.011); delayed graft function occurred more frequently (42 vs. 23%; p = 0.038); and the eGFR at the time of first biopsy was significantly worse (21 vs. 29 ml/min/1.73m2; p = 0.037). In a multivariate logistic regression analysis, eGFR at the time of first biopsy (OR 0.958, 95%-Cl: 0.924-0.993, p = 0.019), dialysis before transplantation (OR 4.868, 95%-Cl: 1.128-21.003, p = 0.034) and the time of first biopsy after transplantation (OR 1.037, 95%-Cl: 1.013-1.062, p = 0.002) were independently associated with CaOx deposition. Graft survival censored for death was significantly worse in patients with CaOx deposition (p = 0.018). In only 1 of 106 preimplantation biopsies CaOx deposition was found (0.94%). CONCLUSION CaOx deposition appears to be primarily recipient-derived and is frequently observed in for-cause renal allograft biopsies obtained within 3 months post-transplantation. It is associated with inferior renal function at the time of biopsy and worse graft survival.
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Affiliation(s)
- Malou L H Snijders
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dennis A Hesselink
- Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Internal Medicine, Division of Nephrology and Transplantation, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marian C Clahsen-van Groningen
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Joke I Roodnat
- Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Internal Medicine, Division of Nephrology and Transplantation, University Medical Center Rotterdam, Rotterdam, The Netherlands
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15
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Waikar SS, Srivastava A, Palsson R, Shafi T, Hsu CY, Sharma K, Lash JP, Chen J, He J, Lieske J, Xie D, Zhang X, Feldman HI, Curhan GC. Association of Urinary Oxalate Excretion With the Risk of Chronic Kidney Disease Progression. JAMA Intern Med 2019; 179:542-551. [PMID: 30830167 PMCID: PMC6450310 DOI: 10.1001/jamainternmed.2018.7980] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Oxalate is a potentially toxic terminal metabolite that is eliminated primarily by the kidneys. Oxalate nephropathy is a well-known complication of rare genetic disorders and enteric hyperoxaluria, but oxalate has not been investigated as a potential contributor to more common forms of chronic kidney disease (CKD). OBJECTIVE To assess whether urinary oxalate excretion is a risk factor for more rapid progression of CKD toward kidney failure. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study assessed 3123 participants with stages 2 to 4 CKD who enrolled in the Chronic Renal Insufficiency Cohort study from June 1, 2003, to September 30, 2008. Data analysis was performed from October 24, 2017, to June 17, 2018. EXPOSURES Twenty-four-hour urinary oxalate excretion. MAIN OUTCOMES AND MEASURES A 50% decline in estimated glomerular filtration rate (eGFR) and end-stage renal disease (ESRD). RESULTS This study included 3123 participants (mean [SD] age, 59.1 [10.6] years; 1414 [45.3%] female; 1423 [45.6%] white). Mean (SD) eGFR at the time of 24-hour urine collection was 42.9 (16.8) mL/min/1.73 m2. Median urinary excretion of oxalate was 18.6 mg/24 hours (interquartile range [IQR], 12.9-25.7 mg/24 hours) and was correlated inversely with eGFR (r = -0.13, P < .001) and positively with 24-hour proteinuria (r = 0.22, P < .001). During 22 318 person-years of follow-up, 752 individuals reached ESRD, and 940 individuals reached the composite end point of ESRD or 50% decline in eGFR (CKD progression). Higher oxalate excretion was independently associated with greater risks of both CKD progression and ESRD: compared with quintile 1 (oxalate excretion, <11.5 mg/24 hours) those in quintile 5 (oxalate excretion, ≥27.8 mg/24 hours) had a 33% higher risk of CKD progression (hazard ratio [HR], 1.33; 95% CI, 1.04-1.70) and a 45% higher risk of ESRD (HR, 1.45; 95% CI, 1.09-1.93). The association between oxalate excretion and CKD progression and ESRD was nonlinear and exhibited a threshold effect at quintiles 3 to 5 vs quintiles 1 and 2. Higher vs lower oxalate excretion (at the 40th percentile) was associated with a 32% higher risk of CKD progression (HR, 1.32; 95% CI, 1.13-1.53) and 37% higher risk of ESRD (HR, 1.37; 95% CI, 1.15-1.63). Results were similar when treating death as a competing event. CONCLUSIONS AND RELEVANCE Higher 24-hour urinary oxalate excretion may be a risk factor for CKD progression and ESRD in individuals with CKD stages 2 to 4.
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Affiliation(s)
- Sushrut S Waikar
- Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anand Srivastava
- Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ragnar Palsson
- Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tariq Shafi
- Division of Nephrology, Johns Hopkins University, Baltimore, Maryland
| | - Chi-Yuan Hsu
- Division of Nephrology, University of California, San Francisco
| | - Kumar Sharma
- Division of Nephrology, University of Texas, San Antonio
| | - James P Lash
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Jing Chen
- Department of Medicine, Tulane University, New Orleans, Louisiana.,Department of Medicine, Tulane University, New Orleans, Louisiana
| | - Jiang He
- Department of Medicine, Tulane University, New Orleans, Louisiana.,Department of Medicine, Tulane University, New Orleans, Louisiana
| | - John Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Dawei Xie
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Xiaoming Zhang
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Harold I Feldman
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Gary C Curhan
- Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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16
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Lin WV, Turin CG, McCormick DW, Haas C, Constantine G. Ascorbic acid-induced oxalate nephropathy: a case report and discussion of pathologic mechanisms. CEN Case Rep 2018; 8:67-70. [PMID: 30276648 DOI: 10.1007/s13730-018-0366-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 09/25/2018] [Indexed: 11/25/2022] Open
Abstract
Oxalate nephropathy is associated with hereditary hyperoxaluria, Crohn disease, and previous gastric or intestinal surgery, especially in the setting of increased oxalate intake or ethylene glycol ingestion. We present a patient whose intake of vitamin C supplements (2 g/day), exacerbated by predisposing factors of prior small bowel obstruction and resection, and benign prostate hyperplasia (BPH), resulted in acute kidney injury due to oxalate nephropathy. We review past reports of vitamin C-induced oxalate nephropathy and discuss the underlying precipitating factors.
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Affiliation(s)
| | - Christie Gloria Turin
- Department of Medicine, Baylor College of Medicine, 7200 Cambridge Street, 10th Floor, Houston, TX, USA.
| | - David Walter McCormick
- Department of Medicine, Baylor College of Medicine, 7200 Cambridge Street, 10th Floor, Houston, TX, USA
| | - Christopher Haas
- Department of Medicine, Baylor College of Medicine, 7200 Cambridge Street, 10th Floor, Houston, TX, USA
| | - Gregory Constantine
- Department of Medicine, Baylor College of Medicine, 7200 Cambridge Street, 10th Floor, Houston, TX, USA
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17
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Martin WP, Docherty NG, le Roux CW. Impact of bariatric surgery on cardiovascular and renal complications of diabetes: a focus on clinical outcomes and putative mechanisms. Expert Rev Endocrinol Metab 2018; 13:251-262. [PMID: 30231777 PMCID: PMC6773600 DOI: 10.1080/17446651.2018.1518130] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Cardiovascular and renal disease accounts for a substantial proportion of the morbidity and mortality associated with obesity and type 2 diabetes mellitus (T2DM). Bariatric surgery is associated with improved long-term cardiovascular and renal outcomes. AREAS COVERED All major case-control, cohort, and randomized controlled trial studies of bariatric surgery in adults with T2DM were screened and data on prespecified cardiovascular and renal outcomes collated. Bariatric surgery reduces all-cause mortality and risk of cardiovascular disease, albuminuria and progressive chronic kidney disease. Patients with poorer glycemic control and established microvascular disease preoperatively may stand to benefit the most from the surgical approach. Reduced sympathetic drive, remission of glomerular hypertension, enhanced natriuresis, gut microbiota shifts, reduced systemic and renal inflammation, improved lipoprotein profiles, and reductions in chronic cardiac remodeling may all be implicated. EXPERT COMMENTARY Ongoing RCTs of bariatric surgery selectively recruiting patients with class 1 obesity and established microvascular complications of diabetes will help to better characterize which subgroups of patients benefit most from this effective therapy.
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Affiliation(s)
- William P. Martin
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, School of Medicine, University College Dublin, Dublin, Ireland
| | - Neil G. Docherty
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, School of Medicine, University College Dublin, Dublin, Ireland
- Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carel W. le Roux
- Diabetes Complications Research Centre, Conway Institute of Biomolecular and Biomedical Research, School of Medicine, University College Dublin, Dublin, Ireland
- Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Division of Investigative Science, Imperial College London, UK
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18
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Abstract
BACKGROUND Bariatric surgery is associated with hyperoxaluria hence predisposing to nephrolithiasis. The present study aimed to investigate the underlying mechanisms contributing to increased urinary oxalate in a mini-gastric bypass (MGB) surgery model in rats under different dietary conditions. The expression of intestinal oxalate transporters was also evaluated. METHODS Male rats underwent MGB (n = 21) or Sham procedure (n = 21) and after recovery were fed a standard or high-fat diet with or without oxalate for 8 weeks. Stool and urine were collected before surgery (baseline) and at the end of protocol (final), when intestinal fragments were harvested for expression of Slc26a3 and Slc26a6 oxalate transporters. RESULTS MGB groups fed with fat, irrespective of oxalate supplementation, presented steatorrhea. In MGB animals fed with fat and oxalate (Fat + Ox), final values of urinary oxalate and calcium oxalate supersaturation risk were markedly and significantly increased versus baseline or Sham animals under the same diet, as well as MGB groups under other diets. Slc26a3 was decreased in biliopancreatic limbs of MGB rats, probably reflecting a physiological adaptation to the restriction of food passage. Slc26a6 was not altered in any harvested intestinal fragment. CONCLUSIONS A high-fat and oxalate diet induced hyperoxaluria and elevation in calcium oxalate supersaturation risk in a MGB rat model. The presence of fat malabsorption and increased dietary oxalate absorption, but not modifications of Slc26a3 and Slc26a6 oxalate transporters, accounted for these findings, suggesting that bariatric patients may benefit from a low-fat and low-oxalate diet.
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19
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Yacoubian AA, Nasr R. Review of post bariatric surgery effects on common genitourinary physiology. Int Braz J Urol 2018; 44:680-687. [PMID: 29412550 PMCID: PMC6092665 DOI: 10.1590/s1677-5538.ibju.2017.0416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/12/2017] [Indexed: 11/27/2022] Open
Abstract
Background: Obesity is a worldwide challenging health problem. Weight loss through medical management of obesity has not always been successful, thus, giving rise to the need for surgical intervention. Bariatric surgery has been shown to be helpful for morbidly obese patients. However, studies have also shown the effect of surgery on stone formation, fertility and erectile function. This review summarizes the main findings of several studies that analyze stone formation and fertility in men as well as erectile function post bariatric surgery. The underlying pathophysiologic alterations post bariatric surgery include increased absorption of oxalate leading to hyperoxaluria, hypocitraturia and increased urinary calcium oxalate supersaturation. Contradicting data exist on the effect of bariatric surgery on fertility and erectile function. Further studies are needed to analyze the mechanisms.
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Affiliation(s)
- Aline A Yacoubian
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rami Nasr
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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20
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Moreland AM, Santa Ana CA, Asplin JR, Kuhn JA, Holmes RP, Cole JA, Odstrcil EA, Van Dinter TG, Martinez JG, Fordtran JS. Steatorrhea and Hyperoxaluria in Severely Obese Patients Before and After Roux-en-Y Gastric Bypass. Gastroenterology 2017; 152:1055-1067.e3. [PMID: 28089681 DOI: 10.1053/j.gastro.2017.01.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 12/22/2016] [Accepted: 01/03/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Hyperoxaluria after Roux-en-Y gastric bypass (RYGB) is generally attributed to fat malabsorption. If hyperoxaluria is indeed caused by fat malabsorption, magnitudes of hyperoxaluria and steatorrhea should correlate. Severely obese patients, prior to bypass, ingest excess dietary fat that can produce hyperphagic steatorrhea. The primary objective of the study was to determine whether urine oxalate excretion correlates with elements of fat balance in severely obese patients before and after RYGB. METHODS Fat balance and urine oxalate excretion were measured simultaneously in 26 severely obese patients before and 1 year after RYGB, while patients consumed their usual diet. At these time points, stool and urine samples were collected. Steatorrhea and hyperoxaluria were defined as fecal fat >7 g/day and urine oxalate >40 mg/day. Differences were evaluated using paired 2-tailed t tests. RESULTS Prior to RYGB, 12 of 26 patients had mild to moderate steatorrhea. Average urine oxalate excretion was 61 mg/day; there was no correlation between fecal fat and urine oxalate excretion. After RYGB, 24 of 26 patients had steatorrhea and urine oxalate excretion averaged 69 mg/day, with a positive correlation between fecal fat and urine oxalate excretions (r = 0.71, P < .001). For each 10 g/day increase in fecal fat output, fecal water excretion increased only 46 mL/day. CONCLUSIONS Steatorrhea and hyperoxaluria were common in obese patients before bypass, but hyperoxaluria was not caused by excess unabsorbed fatty acids. Hyperphagia, obesity, or metabolic syndrome could have produced this previously unrecognized hyperoxaluric state by stimulating absorption or endogenous synthesis of oxalate. Hyperoxaluria after RYGB correlated with steatorrhea and was presumably caused by excess fatty acids in the intestinal lumen. Because post-bypass steatorrhea caused little increase in fecal water excretion, most patients with steatorrhea did not consider themselves to have diarrhea. Before and after RYGB, high oxalate intake contributed to the severity of hyperoxaluria.
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Affiliation(s)
- Amber M Moreland
- Division of Gastroenterology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
| | - Carol A Santa Ana
- Division of Gastroenterology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
| | - John R Asplin
- Litholink Corporation, Laboratory Corporation of America® Holdings, Chicago, Illinois
| | - Joseph A Kuhn
- Division of Gastroenterology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
| | - Ross P Holmes
- Department of Urology, University of Alabama, Birmingham, Alabama
| | - Jason A Cole
- Division of Gastroenterology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
| | - Elizabeth A Odstrcil
- Division of Gastroenterology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
| | - Thomas G Van Dinter
- Division of Gastroenterology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
| | - Juan G Martinez
- Division of Gastroenterology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
| | - John S Fordtran
- Division of Gastroenterology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas.
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21
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Canales BK, Hatch M. Oxalobacter formigenes colonization normalizes oxalate excretion in a gastric bypass model of hyperoxaluria. Surg Obes Relat Dis 2017; 13:1152-1157. [PMID: 28552742 DOI: 10.1016/j.soard.2017.03.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/12/2017] [Accepted: 03/13/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hyperoxaluria and oxalate kidney stones frequently develop after Roux-en-Y gastric bypass (RYGB). Oxalobacter formigenes can degrade ingested oxalate. OBJECTIVES Examine the effect of O. formigenes wild rat strain (OXWR) colonization on urinary oxalate excretion and intestinal oxalate transport in a hyperoxaluric RYGB model. SETTING Basic Science Laboratory, United States. METHODS At 21 weeks of age, 28 obese male Sprague-Dawley rats survived Sham (n = 10) or RYGB (n = 18) surgery and were maintained on a 1.5% potassium oxalate, 40% fat diet. At 12 weeks postoperatively, half the animals in each group were gavaged with OXWR. At 16 weeks, percent dietary fat content was lowered to 10%. Urine and stool were collected weekly to determine oxalate and colonization status, respectively. At week 20, [14 C]-oxalate fluxes and electrical parameters were measured in vitro across isolated distal colon and jejunal (Roux limb) tissue mounted in Ussing Chambers. RESULTS RYGB animals lost 22% total weight while Shams gained 5%. On a moderate oxalate diet, urinary oxalate excretion was 4-fold higher in RYGB than Sham controls. OXWR colonization, obtained in all gavaged animals, reduced urinary oxalate excretion 74% in RYGB and 39% in Sham and was further augmented by lowering the percentage of dietary fat. Finally, OXWR colonization significantly enhanced basal net colonic oxalate secretion in both groups. CONCLUSIONS In our model, OXWR lowered urinary oxalate by luminal oxalate degradation in concert with promotion of enteric oxalate elimination. Trials of O. formigenes colonization and low-fat diet are warranted in calcium oxalate stone formers with gastric bypass and resistant hyperoxaluria.
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Affiliation(s)
- Benjamin K Canales
- Department of Urology, North Florida/South Georgia Veterans Affairs Medical Center and University of Florida, Gainesville, Florida.
| | - Marguerite Hatch
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, Florida
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22
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Espino-Grosso PM, Canales BK. Kidney Stones After Bariatric Surgery: Risk Assessment and Mitigation. Bariatr Surg Pract Patient Care 2017; 12:3-9. [PMID: 28465866 DOI: 10.1089/bari.2016.0048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Obesity is rampant across the spectrum of age, gender, and race in the Unites States. Paralleling this epidemic, kidney stone prevalence is also rising, affecting nearly 1 in 11 individuals. Bariatric surgical procedures, such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), are the most effective weight loss options for morbidly obese or severely obese individuals with comorbidities. A number of studies have linked kidney stone development to bariatric surgical history, particularly RYGB, which portends up to a threefold increase in calcium oxalate stone risk compared with age-matched, obese controls. Stone development after malabsorptive (RYGB) and restrictive (SG) bariatric procedures are driven primarily by alterations in 24-h urine profiles, such as increased urinary oxalate, decreased urine volume, and reduced urinary citrate levels-all of which have been linked to increased kidney stone risk. What clinical recommendations, if any, can be given to reduce kidney stone risk in bariatric kidney stone patients? This review provides not only updated stone incidence and 24-h urine data in this population, but also reassurance-the metabolic alterations that result from bariatric surgery can be successfully mitigated by increased provider awareness, patient education, and a combination of dietary and pharmacological adjustments.
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Bhatti UH, Duffy AJ, Roberts KE, Shariff AH. Nephrolithiasis after bariatric surgery: A review of pathophysiologic mechanisms and procedural risk. Int J Surg 2016; 36:618-623. [PMID: 27847289 DOI: 10.1016/j.ijsu.2016.11.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 11/10/2016] [Indexed: 12/16/2022]
Abstract
Obesity alone is a known risk factor for nephrolithiasis, and bariatric surgery has been linked to a higher incidence of post-operative new-onset nephrolithiasis. The mean interval from bariatric surgery to diagnosis of nephrolithiasis, ranges from 1.5 to 3.6 years. The stone risk is greatest for purely malabsorptive procedures, intermediate for Roux-en-Y gastric bypass and lowest for purely restrictive procedures (laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy) where it approaches or is reduced below that of non-operative obese controls. A history of nephrolithiasis and increasing age at the time of surgery are both associated with an increased risk of new stone formation post-operatively. The underlying pathophysiologic changes following bariatric surgery include increased colonic absorption of oxalate leading to hyperoxaluria, hypocitraturia and increased urinary calcium oxalate supersaturation, which predispose to stone formation. The majority of incident stones are medically managed, with some requiring interventions in the form of lithotripsy or ureteroscopy.
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Affiliation(s)
- Umer Hasan Bhatti
- Aga Khan University Hospital, Department of Surgery, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan
| | - Andrew J Duffy
- Yale University School of Medicine, Department of Surgery, 40 Temple Street, Suite 7B, New Haven, CT, 06510, USA
| | - Kurt Eric Roberts
- Yale University School of Medicine, Department of Surgery, 40 Temple Street, Suite 7B, New Haven, CT, 06510, USA
| | - Amir Hafeez Shariff
- Aga Khan University Hospital, Department of Surgery, Stadium Road, P. O. Box 3500, Karachi, 74800, Pakistan.
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Gkentzis A, Kimuli M, Cartledge J, Traxer O, Biyani CS. Urolithiasis in inflammatory bowel disease and bariatric surgery. World J Nephrol 2016; 5:538-546. [PMID: 27872836 PMCID: PMC5099600 DOI: 10.5527/wjn.v5.i6.538] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 07/31/2016] [Accepted: 10/09/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To analyse current literature focusing on pathogenesis and therapeutic aspects of urolithiasis with inflammatory bowel disease (IBD) and following bariatric surgery.
METHODS A systematic literature search was performed using PubMed, supplemented with additional references. Studies assessing the association of IBD or bariatric surgery with renal stones in both paediatric and adulthood were included.
RESULTS Certain types of stones are seen more frequently with IBD. Hyperoxaluria and hypocitraturia are the main metabolic changes responsible for urolithiasis. The incidence of renal stones in malabsorptive types of bariatric surgery such as gastric bypass is high; this is not as common in modern restrictive surgical methods. Preventative methods and urine alkalinisation have been shown to be beneficial.
CONCLUSION Both conditions are associated with renal stones. Patients’ counselling and prevention strategies are the mainstay of urolithiasis management in these patients.
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Jin HY, Park TS, Lee KA, Baek YH. THE INFLUENCE OF TOTAL OR SUB-TOTAL GASTRECTOMY ON GLUCOSE CONTROL IN DIABETIC AND NON-DIABETIC PATIENTS. ACTA ENDOCRINOLOGICA-BUCHAREST 2016; 12:423-430. [PMID: 31149126 DOI: 10.4183/aeb.2016.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective Although bariatric surgery including gastrectomy has recently emerged as a useful treatment for type 2 DM with obesity, it is not clear whether gastrectomy itself can have beneficial effects on glucose metabolism. Therefore, in this study, we investigated changes in blood glucose in patients with and without diabetes who underwent gastrectomy. Methods From Jan 2010 to May 2014, 77 patients with diabetes and 77 patients without diabetes who underwent gastrectomy at Chonbuk National University Hospital, South Korea, were included. We compared fasting plasma glucose levels and HbA1c value before and after gastric surgery. Results After gastrectomy, 59 patients (38.3%) showed reduced fasting plasma glucose levels at the 1 year point, and 80 patients (51.9%) exhibited reduced fasting plasma glucose at 3 years, irrespective of their diabetes status. Among 77 patients with diabetes, decreased fasting plasma glucose was observed in 22 (28.6%) and 46 patients (59.7%) 1 and 3 years after gastrectomy, respectively. In patients who exhibited reduced fasting plasma glucose after gastrectomy, the degree of reduced glucose was as follows: 56.4±48.5 vs 23.2±16.1 mg/dL after 1 year, 58.3±52.3 vs 18.4±13.7 mg/dL after 3 years, in DM and non-DM patient respectively. Conclusions Although there was a significant drop in mean fasting glucose after gastrectomy, not all patients experienced a drop in fasting glucose. Gastrectomy did not show a consistent association with glucose reduction in patients with and without diabetes, and in about half of the patients, fasting plasma glucose levels increased after gastrectomy. Therefore, bariatric surgery including gastrectomy needs to be performed with care in diabetes, and glucose monitoring including oral glucose tolerance tests should be done for assessing or prediction of the glucose state after gastric surgery in non-DM patients.
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Affiliation(s)
- H Y Jin
- Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University - Chonbuk National University Hospital, Division of Endocrinology and Metabolism, Dept. of Internal Medicine, Jeonju, South Korea
| | - T S Park
- Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University - Chonbuk National University Hospital, Division of Endocrinology and Metabolism, Dept. of Internal Medicine, Jeonju, South Korea
| | - K A Lee
- Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University - Chonbuk National University Hospital, Division of Endocrinology and Metabolism, Dept. of Internal Medicine, Jeonju, South Korea
| | - Y H Baek
- Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University - Chonbuk National University Hospital, Division of Endocrinology and Metabolism, Dept. of Internal Medicine, Jeonju, South Korea
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Agrawal V, Wilfong JB, Rich CE, Gibson PC. Reversal of Gastric Bypass Resolves Hyperoxaluria and Improves Oxalate Nephropathy Secondary to Roux-en-Y Gastric Bypass. Case Rep Nephrol Dial 2016; 6:114-119. [PMID: 27781207 PMCID: PMC5073683 DOI: 10.1159/000449128] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 08/14/2016] [Indexed: 11/19/2022] Open
Abstract
Hyperoxaluria after Roux-en-Y gastric bypass (RYGB) increases the risk for kidney injury. Medical therapies for hyperoxaluria have limited efficacy. A 65-year-old female was evaluated for acute kidney injury [AKI, serum creatinine (Cr) 2.1 mg/dl, baseline Cr 1.0 mg/dl]. She did not have any urinary or gastrointestinal symptoms or exposure to nephrotoxic agents. Sixteen months prior to this evaluation, she underwent RYGB for morbid obesity. Her examination was unremarkable for hypertension or edema and there was no protein or blood on urine dipstick. Kidney biopsy revealed acute tubulointerstitial nephritis with oxalate crystals in tubules. The concurrent finding of severe hyperoxaluria (urine oxalate 150 mg/day) confirmed the diagnosis of oxalate nephropathy. Despite medical management of hyperoxaluria, her AKI worsened. Laparoscopic reversal of RYGB was performed and within 1 month, her hyperoxaluria resolved (urine oxalate 20 mg/day) and AKI improved (Cr 1.7 mg/dl). Surgical reversal of RYGB may be considered in patients with oxalate nephropathy at high risk of progression who fail medical therapy. Physicians need to be aware of the possibility of oxalate nephropathy after RYGB and promptly treat the hyperoxaluria to halt further kidney damage.
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Affiliation(s)
- Varun Agrawal
- Division of Nephrology and Hypertension, University of Vermont, Burlington, Vt., USA
| | | | | | - Pamela C Gibson
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vt., USA
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Abstract
Objective: To present an updated description of the relation between Crohn's disease (CD) and Urolithiasis. Patients and Methods: A literature search for English-language original and review articles was conducted in Medline, Embase, and Cochrane databases in the month of December 2014 for papers either published or e-published up to that date, addressing the association between CD and urolithiasis as its consequence. All articles published in English language were selected for screening based on the following search terms: “CD,” “renal calculus,” “IBD,” and “urolithiasis.” We restricted the publication dates to the last 15 years (2000–2014). Results: In total, 901 patients were included in this review of which 95 were identified as having CD and urolithiasis simultaneously, for a total of 10.5%. Average age was 45.07 years old, irrespective of gender. 28.6% of patients received some kind of medical intervention without any kind of surgical technique involved, 50% of patients were submitted to a surgical treatment, and the remaining 21.4% were submitted to a combination of surgical and medical treatment. Urolithiasis and pyelonephritis incidence ranged from 4% to 23% with a risk 10–100 times greater than the risk for general population or for patients with UC, being frequent in patients with ileostomy and multiple bowel resections. We found that urolithiasis occurred in 95 patients from a total of 901 patients with CD (10.5%); 61.81% in men and 38.19% in women. Stone disease seems to present approximately 4–7 years after the diagnosis of bowel disease and CaOx seems to be the main culprit. Conclusions: CD is a chronic, granulomatous bowel disease, with urolithiasis as the most common extraintestinal manifestation (EIM), particularly frequent in patients submitted to bowel surgery. This complication needs to be recognized and addressed appropriately, especially in patients with unexplained renal dysfunction, abdominal pain, or recurrent urinary tract infection. We believe this study to be an updated valuable review as most data related to this kind of EIM refers to articles published before 2000, most of them before 1990. These patients need to be followed up with a specific prevention plan to eliminate or mitigate the risk factors for stone disease, aiming at preventing its formation and its complications, preserving renal function, reducing morbidity, and ultimately improving their quality of life.
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Affiliation(s)
| | - Tiago Mendonça
- Department of Urology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Pedro Oliveira
- Department of Urology, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Tiago Oliveira
- Department of Urology, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - José Dias
- Department of Urology, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Tomé Lopes
- Department of Urology, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
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Upala S, Jaruvongvanich V, Sanguankeo A. Risk of nephrolithiasis, hyperoxaluria, and calcium oxalate supersaturation increased after Roux-en-Y gastric bypass surgery: a systematic review and meta-analysis. Surg Obes Relat Dis 2016; 12:1513-1521. [PMID: 27396545 DOI: 10.1016/j.soard.2016.04.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/29/2016] [Accepted: 04/04/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Earlier publications have shown renal stone complications after bariatric surgery. Multiple reports have also linked metabolic changes that alter the urinary chemistry profiles, especially hyperoxaluria, after bariatric surgery. However, evidence on change of other urine chemistry studies and type of bariatric surgery and risk of stone has been inconclusive so far. OBJECTIVES To explore the association between bariatric surgery and postoperative urinary chemistry change and risk of stone formation SETTING: A systematic review and meta-analysis. METHODS We comprehensively searched the databases of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) from their dates of inception to January 2016. The inclusion criteria were published studies of association between bariatric surgery and postoperative renal stone formation or urine chemistry profiles. We used random-effects model meta-analysis and calculated the pooled risk of renal stone and difference in 24-hour urine chemistry profiles. RESULTS Twelve observational studies were included in the meta-analysis. There was significantly higher risk of stone formation after Roux-en-Y gastric bypass surgery with pooled relative risk = 1.79 (95% CI: 1.54-2.10). In the analysis of urine chemistry profiles, there was significantly higher calcium oxalate supersaturation, lower citrate, and lower volume postoperatively compared with preoperatively. There was also higher urine oxalate in patients who had bariatric surgery compared with nonsurgery controls. CONCLUSIONS Roux-en-Y gastric bypass surgery is associated with higher risk of renal stone and increased urine oxalate and calcium oxalate supersaturation.
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Affiliation(s)
- Sikarin Upala
- Department of Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, New York; Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Veeravich Jaruvongvanich
- Department of Internal Medicine, University of Hawaii, Honolulu, Hawaii; Department of Internal Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Anawin Sanguankeo
- Department of Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, New York; Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Sakhaee K, Poindexter J, Aguirre C. The effects of bariatric surgery on bone and nephrolithiasis. Bone 2016; 84:1-8. [PMID: 26679435 PMCID: PMC4827266 DOI: 10.1016/j.bone.2015.12.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/13/2015] [Accepted: 12/04/2015] [Indexed: 12/25/2022]
Abstract
The impact of bariatric surgery on cardiovascular and diabetic complications associated with an improvement in survival has overshadowed the adverse skeletal health and development of kidney stone disease in this population. All longitudinal based studies in the literature reporting the incidence of bone fractures or kidney stones following bariatric surgery were reviewed. Moreover, all publications over the past decade which assessed changes in bone mineral density and bone quality, or explored underlying pathophysiologic mechanisms of bone and kidney stone disease were carefully reviewed. This review provides sufficient data to support that osteoporotic fractures and kidney stone disease are associated with Roux-en-Y gastric bypass surgery. However, due to the limited data available to date, no definitive conclusion could yet be drawn whether sleeve gastrectomy or adjustable gastric banding is associated with bone fractures and kidney stones. Bariatric surgery has emerged as the most effective and sustained treatment for weight reduction. This treatment modality has been recognized to diminish the risk of cardiovascular morbidity and mortality and ameliorate diabetes mellitus complications. The derangement in mineral metabolism has emerged as a major complication following bariatric surgery.
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Affiliation(s)
- Khashayar Sakhaee
- Department of Internal Medicine, Division of Mineral Metabolism, Charles & Jane Pak Center for Mineral Metabolism & Clinical Research,University of Texas Southwestern Medical Center, Dallas, TX, United States.
| | - John Poindexter
- Department of Internal Medicine, Division of Mineral Metabolism, Charles & Jane Pak Center for Mineral Metabolism & Clinical Research,University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Crystal Aguirre
- Department of Internal Medicine, Division of Mineral Metabolism, Charles & Jane Pak Center for Mineral Metabolism & Clinical Research,University of Texas Southwestern Medical Center, Dallas, TX, United States
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The mechanistic basis of hyperoxaluria following gastric bypass in obese rats. Urolithiasis 2015; 44:221-30. [PMID: 26584912 DOI: 10.1007/s00240-015-0836-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/02/2015] [Indexed: 01/06/2023]
Abstract
Roux-en-Y gastric bypass (RYGB) surgery is a popular and extremely effective procedure for sustained weight loss in the morbidly obese. However, hyperoxaluria and oxalate kidney stones frequently develop after RYGB and steatorrhea has been speculated to play a role. We examined the effects of RYGB and the role of dietary fat in an obese rat model by measuring fecal fat content and transmural oxalate fluxes across the distal colon compared to sham-operated controls (SHAM). Direct measurements of fecal fat content confirmed that RYGB on a 10 % fat diet excreted 40-fold more fecal fat than SHAM and, on a 40 % fat diet, RYGB excreted sevenfold more fecal fat than SHAM fed similarly. Results from the transport studies revealed a clear effect of high dietary fat (40 %) on colonic oxalate permeability and tissue conductance (G T) with comparable oxalate fluxes in RYGB and in SHAM. Administering a diet containing 10 % fat to both groups distinguished differences between RYGB and SHAM, revealing a 40 % increase in G T in RYGB and a reversal in the direction of net oxalate flux from absorption in SHAM to secretion in RYGB. These changes in colonic oxalate permeability were associated with a fourfold increase in urinary oxalate excretion in RYGB compared to SHAM. Therefore, oxalate solubility and permeability in the RYGB model are promoted by steatorrhea and result in enhanced passive oxalate absorption and hyperoxaluria. To our knowledge, these are the first measurements of intestinal oxalate transport in rats with RYGB.
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Bretault M, Hertig A, Carette C, Czernichow S. Quiz Page September 2015. Am J Kidney Dis 2015; 66:A17-9. [DOI: 10.1053/j.ajkd.2015.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/08/2015] [Indexed: 11/11/2022]
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dos Santos MVR, Ferreira GEC, de Oliveira ECP, Kreimer F, Campos JM, Ferraz AAB. Metabolic and endocrinological factors related to nephrolithiasis pre and post multiple techniques of bariatric surgery: a sistematic review. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2015; 27 Suppl 1:69-72. [PMID: 25409971 PMCID: PMC4743524 DOI: 10.1590/s0102-6720201400s100017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 07/24/2014] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Despite of benefits of bariatric surgery for obesity treatment, the procedure may be related to some complications. AIM Analyze studies to address the relation between nephrolithiasis and bariatric surgery. METHODS Ten papers about this theme were selected from 2005-2013 in Pubmed, describing the relation of nephrolithiasis or their risk factors with several types of bariatric surgery. RESULTS Retrospective studies with minimal follow-up of three years demonstrated 7,65% in surgery patients and 4,63% non-surgery with nephrolithiasis (p<0,05). Prospective studies (8 of 10) revealed large percentage of calculi appearing and significant increase in oxaluria. CONCLUSION There is correlation between obesity surgery and nephrolithiasis.
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Affiliation(s)
| | | | | | - Flavio Kreimer
- Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, PE, Brazil
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Lieske JC, Mehta RA, Milliner DS, Rule AD, Bergstralh EJ, Sarr MG. Kidney stones are common after bariatric surgery. Kidney Int 2015; 87:839-45. [PMID: 25354237 PMCID: PMC4382441 DOI: 10.1038/ki.2014.352] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 08/20/2014] [Accepted: 09/04/2014] [Indexed: 12/22/2022]
Abstract
Obesity, a risk factor for kidney stones and chronic kidney disease (CKD), is effectively treated with bariatric surgery. However, it is unclear whether surgery alters stone or CKD risk. To determine this we studied 762 Olmsted County, Minnesota residents who underwent bariatric surgery and matched them with equally obese control individuals who did not undergo surgery. The majority of bariatric patients underwent standard Roux-en-Y gastric bypass (RYGB; 78%), with the remainder having more malabsorptive procedures (very long limb RYGB or biliopancreatic diversion/duodenal switch; 14%) or restrictive procedures (laparoscopic banding or sleeve gastrectomy; 7%). The mean age was 45 years with 80% being female. The mean preoperative body mass index (BMI) was 46.7 kg/m(2) for both cohorts. Rates of kidney stones were similar between surgery patients and controls at baseline, but new stone formation significantly increased in surgery patients (11.0%) compared with controls (4.3%) during 6.0 years of follow-up. After malabsorptive and standard surgery, the comorbidity-adjusted hazard ratio of incident stones was significantly increased to 4.15 and 2.13, respectively, but was not significantly changed for restrictive surgery. The risk of CKD significantly increased after the malabsorptive procedures (adjusted hazard ratio of 1.96). Thus, while RYGB and malabsorptive procedures are more effective for weight loss, both are associated with increased risk of stones, while malabsorptive procedures also increase CKD risk.
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Affiliation(s)
- John C. Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Ramila A. Mehta
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Dawn S. Milliner
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
- Division of Epidemiology, Mayo Clinic, Rochester, MN
| | - Eric J. Bergstralh
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
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Abstract
Over the past 10 years, a variety of reports have linked bariatric surgery to metabolic changes that alter kidney stone risk. Most of these studies were retrospective, lacked appropriate controls, or involved bariatric patients with a variety of inclusion criteria. Despite these limitations, recent clinical and experimental research has contributed to our understanding of the pathophysiology of stone disease in this high-risk population. This review summarizes the urinary chemistry profiles that may be responsible for the increased kidney stone incidence seen in contemporary epidemiological bariatric studies, outlines the mechanisms of hyperoxaluria and potential therapies through a newly described experimental bariatric animal model, and provides a focused appraisal of recommendations for reducing stone risk in bariatric stone formers.
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Karaolanis G, Lionaki S, Moris D, Palla VV, Vernadakis S. Secondary hyperoxaluria: a risk factor for kidney stone formation and renal failure in native kidneys and renal grafts. Transplant Rev (Orlando) 2014; 28:182-7. [PMID: 24999029 DOI: 10.1016/j.trre.2014.05.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 05/18/2014] [Accepted: 05/21/2014] [Indexed: 12/22/2022]
Abstract
Secondary hyperoxaluria is a multifactorial disease affecting several organs and tissues, among which stand native and transplanted kidneys. Nephrocalcinosis and nephrolithiasis may lead to renal insufficiency. Patients suffering from secondary hyperoxaluria, should be promptly identified and appropriately treated, so that less renal damage occurs. The aim of this review is to underline the causes of hyperoxaluria and the related pathophysiologic mechanisms, which are involved, along with the description of seven cases of irreversible renal graft injury due to secondary hyperoxaluria.
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Affiliation(s)
- Georgios Karaolanis
- Transplantation Unit, Laiko General Hospital, Medical School of Athens, Athens, Greece.
| | - Sophia Lionaki
- Nephrology and Transplantation Unit, Laiko Hospital, Athens, Greece
| | - Demetrios Moris
- Transplantation Unit, Laiko General Hospital, Medical School of Athens, Athens, Greece
| | | | - Spiridon Vernadakis
- Transplantation Unit, Laiko General Hospital, Medical School of Athens, Athens, Greece
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Valezi AC, Fuganti PE, Junior JM, Delfino VD. Urinary evaluation after RYGBP: a lithogenic profile with early postoperative increase in the incidence of urolithiasis. Obes Surg 2014; 23:1575-80. [PMID: 23519632 DOI: 10.1007/s11695-013-0916-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The objective of this study was to assess predictors for new-onset stone formers after Roux-en-Y gastric bypass (RYGBP). METHODS One hundred and fifty-one obese patients underwent RYGBP and were followed for 1 year. The analysis comprised two study time points: preoperative (T0) and 1 year after surgery (T1). They were analyzed for urinary stones, blood tests, and 24-h urinary evaluation. Nonparametric tests, logistic regression, and multivariate analysis were conducted using SPSS 17. RESULTS Median BMI decreased from 44.1 to 27.0 kg/m2 (p < 0.001) in the postoperative period. Urinary oxalate (24 versus 41 mg; p < 0.001) and urinary uric acid (545 versus 645 mg; p < 0.001) increased significantly postoperatively (preoperative versus postoperative, respectively). Urinary volume (1310 versus 930 ml; p < 0.001), pH (6.3 versus 6.2; p = 0.019), citrate (268 versus 170 mg; p < 0.001), calcium (195 versus 105 mg; p < 0.001), and magnesium (130 versus 95 mg; p = 0.004) decreased significantly postoperatively (preoperative versus postoperative, respectively). Stone formers increased from 16 (10.6 %) to 27 (17.8%) patients in the postoperative analysis (p = 0.001). Predictors for new stone formers after RYGBP were postoperative urinary oxalate (p = 0.015) and uric acid (p = 0.044). CONCLUSIONS RYGBP determined profound changes in urinary composition which predisposed to a lithogenic profile. The prevalence of urinary lithiasis increased almost 70% in the postoperative period. Postoperative urinary oxalate and uric acid were the only predictors for new stone formers.
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Affiliation(s)
- Antonio Carlos Valezi
- Department of Surgery, State University of Londrina, Rua Santos 777 apto 1302, 86020041, Londrina, Brazil,
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Kidney stone incidence and metabolic urinary changes after modern bariatric surgery: review of clinical studies, experimental models, and prevention strategies. Surg Obes Relat Dis 2014; 10:734-42. [PMID: 24969092 DOI: 10.1016/j.soard.2014.03.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/06/2014] [Accepted: 03/08/2014] [Indexed: 12/19/2022]
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Neff KJ, Frankel AH, Tam FWK, Sadlier DM, Godson C, le Roux CW. The effect of bariatric surgery on renal function and disease: a focus on outcomes and inflammation. Nephrol Dial Transplant 2013; 28 Suppl 4:iv73-82. [PMID: 24071659 DOI: 10.1093/ndt/gft262] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Renal dysfunction and disease, including hyperfiltration, proteinuria and hypofiltration, are commonly associated with obesity. Diabetic kidney disease is also common in obese cohorts. Weight loss interventions, including bariatric surgery, can effectively reduce weight and improve renal outcomes. Some of this effect may be due to the remission of Type 2 diabetes and hypertension. However, other mechanisms, including the resolution of inflammatory processes, may also contribute. The effect of bariatric surgery on renal function has only recently become a focus of particular investigation. In this study, we will review the effects of bariatric surgery on obesity-associated kidney disease. We will discuss the pitfalls in assessing renal function in obese cohorts and will examine the effect of bariatric surgery on renal function and urinary protein excretion using different mechanisms. We will give particular attention to the evidence for bariatric surgery in cohorts with established renal disease and suggest future directions. In particular, we will outline the evidence for inflammation as an important therapeutic target, and the emerging medical therapies being considered to exploit this target in obesity- and diabetes-related kidney disease.
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Affiliation(s)
- Karl J Neff
- Diabetic Complication Research Centre, UCD Conway Institute, School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland
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Shimizu H, Ichikawa D, Tamagaki K, Komatsu S, Kubota T, Okamoto K, Shiozaki A, Fujiwara H, Ota N, Otsuji E. Evaluation of postoperative nephrolithiasis and renal dysfunction in gastric cancer patients. Gastric Cancer 2013; 16:338-44. [PMID: 22948316 DOI: 10.1007/s10120-012-0192-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 08/13/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Roux-en-Y (R-Y) gastric bypass, also known as bariatric surgery, sometimes causes postoperative hyperoxaluria and subsequent oxalate nephrolithiasis in obese patients. In this study, we retrospectively investigated the frequency of occurrence of nephrolithiasis and renal dysfunction in postoperative gastric cancer patients with respect to the surgical procedures employed. METHODS Two hundred and twenty-six consecutive gastric cancer patients, who underwent distal gastrectomy with Billroth-I reconstruction (DGBI, 60 patients), distal gastrectomy with R-Y reconstruction (DGRY, 81 patients), and total gastrectomy with R-Y reconstruction (TGRY, 85 patients), were investigated for postoperative nephrolithiasis and renal dysfunction. We also examined the risk factors for postoperative nephrolithiasis in these patients with gastric cancer. RESULTS Nephrolithiasis was detected in 3 (5%), 7 (9%), and 21 (25%) patients in the DGBI, DGRY, and TGRY groups, respectively. There were significant differences in the frequency of nephrolithiasis between the DGBI and TGRY groups (p = 0.004), and between the DGRY and TGRY groups (p = 0.011), but there was no significant difference between the DGBI and DGRY groups. Multivariate logistic regression analysis revealed that gender and extent of gastrectomy were independent risk factors associated with nephrolithiasis. Renal dysfunction was found in 5 patients (6%) in the TGRY group, but was not found in either the DGBI or the DGRY group. Nephrolithiasis was detected in all these 5 patients, and a renal biopsy performed in one patient revealed the presence of intratubular calcium oxalate crystals with chronic tubulointerstitial nephritis. CONCLUSION Total gastrectomy with R-Y reconstruction was an independent predictive factor for nephrolithiasis in patients with gastric cancer.
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Affiliation(s)
- Hiroki Shimizu
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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Agrawal V, Liu XJ, Campfield T, Romanelli J, Enrique Silva J, Braden GL. Calcium oxalate supersaturation increases early after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2013; 10:88-94. [PMID: 23953730 DOI: 10.1016/j.soard.2013.03.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 03/22/2013] [Accepted: 03/23/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Calcium oxalate (CaOx) nephrolithiasis is an adverse effect of Roux-en-Y gastric bypass surgery (RYGB). It is unknown when the increased risk for CaOx stone formation occurs after surgery. METHODS We studied 13 morbidly obese adults undergoing RYGB with 24-hour urine collections at 4 weeks before and 1, 2, 4, and 6 months after surgery and computed CaOx relative saturation ratio (RSR) by EQUIL2. RESULTS Eleven patients were female, mean ± standard deviation age was 41.1 ± 7.2 years, and none had diabetes or chronic kidney disease. Median (interquartile range) urinary oxalate excretion increased linearly from 12.6 (10.9-37.9) mg/24 hr at baseline to 28.4 (14.4-44.0) mg/24 hr at 6 months (slope = .188; P = .005). CaOx RSR increased significantly at 2 months after RYGB (1.4 [1.2-2.4] to 4.9 [1.7-10.0]; P = .017) and rose throughout the study to 5.7 (3.7-12.2) at 6 months (P = .001) with a positive linear slope (.255; P = .001). One patient had critical CaOx supersaturation (RSR = 34.7) and severe hyperoxaluria (101.7 mg/24 hr) at 6 months after RYGB. Significant decreases over time were seen in urine volume and sodium and potassium excretion, but no changes were noted in urinary pH, calcium, magnesium, or citrate. CONCLUSIONS Our data suggest that CaOx RSR, and thus risk for nephrolithiasis, rises as early as 2 months after RYGB and increases gradually in the first 6 months, largely because of reduced urine volume and increased urinary oxalate excretion. Interventions to reduce CaOx RSR, such as adequate fluid intake and agents to bind enteric oxalate, need to be evaluated in patients at risk for nephrolithiasis after RYGB.
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Affiliation(s)
- Varun Agrawal
- Division of Nephrology and Hypertension, Fletcher Allen Health Care, Burlington, Vermont.
| | - Xiao J Liu
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts and Tufts University School of Medicine, Boston, Massachusetts
| | - Thomas Campfield
- Department of Pediatrics, Baystate Medical Center, Springfield, Massachusetts and Tufts University School of Medicine, Boston, Massachusetts
| | - John Romanelli
- Department of Surgery, Baystate Medical Center, Springfield, Massachusetts and Tufts University School of Medicine, Boston, Massachusetts
| | - J Enrique Silva
- Division of Endocrinology, Baystate Medical Center, Springfield, Massachusetts and Tufts University School of Medicine, Boston, Massachusetts
| | - Gregory L Braden
- Renal Division, Baystate Medical Center, Springfield, Massachusetts and Tufts University School of Medicine, Boston, Massachusetts
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Canales BK, Ellen J, Khan SR, Hatch M. Steatorrhea and hyperoxaluria occur after gastric bypass surgery in obese rats regardless of dietary fat or oxalate. J Urol 2013; 190:1102-9. [PMID: 23499748 DOI: 10.1016/j.juro.2013.02.3229] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 02/20/2013] [Indexed: 12/14/2022]
Abstract
PURPOSE We determined the effect of dietary fat and oxalate on fecal fat excretion and urine parameters in a rat model of Roux-en-Y gastric bypass surgery. MATERIALS AND METHODS Diet induced obese Sprague-Dawley® rats underwent sham surgery as controls (16), or Roux-en-Y gastric bypass surgery (19). After recovery, rats had free access to a normal calcium, high fat (40%) diet with or without 1.5% potassium oxalate for 5 weeks and then a normal (10%) fat diet for 2 weeks. Stool and urine were collected after each period. Fecal fat was determined by gas chromatography and urine metabolites were evaluated by assay spectrophotometry. RESULTS Daily fecal fat excretion remained low in controls on either diet. However, Roux-en-Y gastric bypass rats ingested a food quantity similar to that of controls but had eightfold higher fecal fat excretion (p <0.001) and heavier stools (p = 0.02). Compared to controls, gastric bypass rats on the high fat diet with potassium oxalate had a fivefold increase in urine oxalate excretion (p <0.001), while gastric bypass rats without potassium oxalate had a twofold increase in urine calcium (p <0.01). Lowering dietary fat in gastric bypass rats with potassium oxalate led to a 50% decrease in oxalate excretion (p <0.01), a 30% decrease in urine calcium and a 0.3 U increase in urine pH (p <0.001). CONCLUSIONS In this Roux-en-Y gastric bypass model high fat feeding resulted in steatorrhea, hyperoxaluria and low urine pH, which were partially reversible by lowering the dietary fat and oxalate content. Roux-en-Y gastric bypass rats on normal fat and no oxalate diets excreted twice as much oxalate as age matched, sham operated controls. Although Roux-en-Y gastric bypass hyperoxaluria appears primarily mediated by gut and diet, secondary causes of oxalogenesis from liver or other mechanisms deserve further exploration.
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Affiliation(s)
- Benjamin K Canales
- Department of Urology, University of Florida, Gainesville, Florida 32610, USA.
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Poesen R, Meijers B, Evenepoel P. The colon: an overlooked site for therapeutics in dialysis patients. Semin Dial 2013; 26:323-32. [PMID: 23458264 DOI: 10.1111/sdi.12082] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Morbidity and mortality related to chronic kidney disease remain unacceptably high, despite tremendous progress in its prevention and treatment. In an ongoing quest to improve outcome in chronic kidney disease patients, the colon might be an appealing, but largely underexplored, therapeutic target. A clear bi-directional functional relationship exists between the colon and kidney, also referred as to the colo-renal axis. Uremia has an important impact on the colonic microbiome. The microbiome, in turn, is an important source of uremic toxins, with p-cresyl sulfate and indoxyl sulfate as important prototypes. These co-metabolites accumulate in the face of a falling kidney function, and may accelerate the progression of renal and cardiovascular disease. Several therapeutic interventions, including prebiotics and adsorbants, specifically target these colon-derived uremic toxins originating from bacterial metabolism. As kidney function declines, the colon also gains importance in the homeostasis and disposal of potassium and oxalate. Their colonic secretion may be increased by drugs increasing the expression of cAMP and by probiotics (e.g., Oxalobacter formigenes).
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Affiliation(s)
- Ruben Poesen
- Division of Nephrology, Department of Microbiology and Immunology, University Hospitals Leuven, Leuven, Belgium
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Troxell ML, Houghton DC, Hawkey M, Batiuk TD, Bennett WM. Enteric oxalate nephropathy in the renal allograft: an underrecognized complication of bariatric surgery. Am J Transplant 2013; 13:501-9. [PMID: 23311979 DOI: 10.1111/ajt.12029] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 10/18/2012] [Accepted: 10/31/2012] [Indexed: 02/06/2023]
Abstract
Enteric hyperoxalosis is a recognized complication of bariatric surgery, with consequent oxalate nephropathy leading to chronic kidney disease and occasionally end-stage renal failure. In patients with prior gastrointestinal bypass surgery, renal allografts are also at risk of oxalate nephropathy. Further, transplant recipients may be exposed to additional causes of hyperoxalosis. We report two cases of renal allograft oxalate nephropathy in patients with remote histories of bariatric surgery. Conservative management led to improvement of graft function in one patient, while the other patient returned to dialysis. Interpretation of serologic, urine and biopsy studies is complicated by oxalate accumulation in chronic renal failure, and heightened excretion in the early posttransplant period. A high index of suspicion and careful clinicopathologic correlation on the part of transplant nephrologists and renal pathologists are required to recognize and treat allograft oxalate nephropathy. As the incidence of obesity and pretransplant bariatric surgery increases in the transplant population, allograft oxalate nephropathy is likely to be an increasing cause of allograft dysfunction.
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Affiliation(s)
- M L Troxell
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA.
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Froeder L, Arasaki CH, Malheiros CA, Baxmann AC, Heilberg IP. Response to dietary oxalate after bariatric surgery. Clin J Am Soc Nephrol 2012; 7:2033-40. [PMID: 23024163 DOI: 10.2215/cjn.02560312] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND OBJECTIVES Bariatric surgery (BS) may be associated with increased oxalate excretion and a higher risk of nephrolithiasis. This study aimed to investigate urinary abnormalities and responses to an acute oxalate load as an indirect assessment of the intestinal absorption of oxalate in this population. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Twenty-four-hour urine specimens were collected from 61 patients a median of 48 months after BS (post-BS) as well as from 30 morbidly obese (MO) participants; dietary information was obtained through 24-hour food recalls. An oral oxalate load test (OLT), consisting of 2-hour urine samples after overnight fasting and 2, 4, and 6 hours after consuming 375 mg of oxalate (spinach juice), was performed on 21 MO and 22 post-BS patients 12 months after BS. Ten post-BS patients also underwent OLT before surgery (pre-BS). RESULTS There was a higher percentage of low urinary volume (<1.5 L/d) in post-BS versus MO (P<0.001). Hypocitraturia and hyperoxaluria (P=0.13 and P=0.36, respectively) were more frequent in BS versus MO patients. The OLT showed intragroup (P<0.001 for all periods versus baseline) and intergroup differences (P<0.001 for post-BS versus MO; P=0.03 for post-BS versus pre-BS). The total mean increment in oxaluria after 6 hours of load, expressed as area under the curve, was higher in both post-BS versus MO and in post-BS versus pre-BS participants (P<0.001 for both). CONCLUSIONS The mean oxaluric response to an oxalate load is markedly elevated in post-bariatric surgery patients, suggesting that increased intestinal absorption of dietary oxalate is a predisposing mechanism for enteric hyperoxaluria.
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Affiliation(s)
- Leila Froeder
- Nephrology Division, Federal University of São Paulo, São Paulo, Brazil
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Pang R, Linnes MP, O'Connor HM, Li X, Bergstralh E, Lieske JC. Controlled metabolic diet reduces calcium oxalate supersaturation but not oxalate excretion after bariatric surgery. Urology 2012; 80:250-4. [PMID: 22554593 DOI: 10.1016/j.urology.2012.02.052] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 01/26/2012] [Accepted: 02/28/2012] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To identify the effect of a controlled metabolic diet on reducing urinary calcium oxalate (CaOx) supersaturation in subjects with hyperoxaluric nephrolithiasis after potentially malabsorptive forms of bariatric surgery. METHODS Subjects with a history of CaOx kidney stones and mild hyperoxaluria after bariatric surgery (n = 9) collected baseline 24-hour urine samples while consuming a free choice diet. They were then instructed to consume a controlled diet low in oxalate (70-80 mg/d), normal in calcium (1000 mg/d), and moderate in protein before 2 final 24-hour urine collections. RESULTS Overall, the urinary CaOx supersaturation decreased from 1.97 ± 0.49 delta Gibbs (DG) with the free choice diet to 1.13 ± 0.75 DG with the controlled diet (P < .01). This occurred in the absence of a significant change in urinary oxalate excretion (0.69 ± 0.29 mmol/d with the free choice diet compared with 0.66 ± 0.38 mmol/d with the controlled diet). Urinary volume, citrate, and pH all increased, although not significantly (P > .05), contributing to the significant CaOx supersaturation change. CONCLUSION A controlled metabolic diet normal in calcium, moderate in protein, and reduced in oxalate can positively affect urinary CaOx supersaturation after bariatric surgery. However, this diet did not appear to decrease urinary oxalate excretion. Therefore, restriction of dietary oxalate alone might not be enough to reduce urinary oxalate excretion to normal levels in this group of patients with known enteric hyperoxaluria. Additional strategies could be necessary, such as the use of oral calcium supplements as oxalate binders and a lower fat diet.
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Affiliation(s)
- Ran Pang
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota 55905, USA
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Buchwald H, Ikramuddin S, Dorman RB, Schone JL, Dixon JB. Management of the metabolic/bariatric surgery patient. Am J Med 2011; 124:1099-105. [PMID: 22014789 DOI: 10.1016/j.amjmed.2011.05.035] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 05/11/2011] [Accepted: 05/11/2011] [Indexed: 01/06/2023]
Abstract
There is currently a global pandemic of obesity and obesity-engendered comorbidities; in particular, certain major chronic metabolic diseases (eg, type 2 diabetes) which markedly reduce life expectancy and quality of life. This review is predicated on the fact that management of the obese patient is a primary concern of all physicians and health care providers, and that metabolic/bariatric surgery is a highly successful therapeutic option for this disease.
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Affiliation(s)
- Henry Buchwald
- Department of Surgery, University of Minnesota, Minneapolis, 55455, USA.
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50
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Wu JN, Craig J, Chamie K, Asplin J, Ali MR, Low RK. Urolithiasis risk factors in the bariatric population undergoing gastric bypass surgery. Surg Obes Relat Dis 2011; 9:83-7. [PMID: 22100051 DOI: 10.1016/j.soard.2011.08.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 08/25/2011] [Accepted: 08/29/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Previous studies have suggested an increased risk of forming symptomatic urolithiasis after Roux-en-Y gastric bypass (RYGB) attributed to the development of hyperoxaluria. The objective of our investigation was to evaluate changes in the urine milieu after RYGB that might explain the increased risk of urolithiasis. METHODS Patients underwent serum and urine chemistry tests 1 week before and 6 months after RYGB at a university hospital. The postoperative urolithiasis risk factors were compared with the preoperative values. Statistical analysis was performed using paired t tests. Significant changes were identified as P ≤ .05. RESULTS A total of 38 patients (7 men and 31 women) submitted samples both before and after RYGB. The mean patient weight had decreased from 131 kg to 92 kg. The mean serum creatinine decreased from .83 to .72 mg/dL (P = .0004). Urinary changes known to increase the risk of urolithiasis include a decrease in volume (2-1.5 L/d, P = .03), an increase in calcium (139-182 mg/d, P = .04), and an increase in oxalate (38-48 mg/d, P < .001). The urinary supersaturation indexes for calcium oxalate (4.9-10.5, P < .001) increased. CONCLUSION Our results confirm that patients undergoing RYGB develop changes in the urinary milieu predisposing them to forming urinary stones. Urolithiasis risk is multifactorial and is related to more than just hyperoxaluria. A patient's long-term risk of developing stones and the effect on renal function is unknown. Preoperative counseling of patients regarding their risk of forming stones and dietary counseling to minimize their risk of developing stones postoperatively is warranted.
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Affiliation(s)
- Jennifer N Wu
- Department of Urology, University of California Davis Medical Center, Sacramento, California 95817, USA.
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