Top

Obesity Surgery

Published in:

01-10-2013 | Original Contributions

Urinary Evaluation After RYGBP: a Lithogenic Profile with Early Postoperative Increase in the Incidence of Urolithiasis

Authors: Antonio Carlos Valezi, Paulo Emilio Fuganti, Jorge Mali Junior, Vinicius Daher Delfino

Published in: Obesity Surgery | Issue 10/2013

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.

Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295:1549–55.PubMedCrossRef

Brazilian Institute of Geography and Statistics. Household budget survey 2002–2003. Ministries of Health and Planning. Rio de Janeiro. Portable document format. http://www.ibge.gov.br/home/estatistica/populacao/condicaodevida/pof/2002analise/analise.pdf (2004). Accessed 31 August 2011.

Taylor EN, Stampfer MJ, Curhan GC. Obesity, weight gain, and the risk of kidney stones. JAMA. 2005;293:455–62.PubMedCrossRef

Powell CR, Stoller ML, Schwartz BF, et al. Impact of body weight on urinary electrolytes in urinary stone formers. Urology. 2000;55:825–30.PubMedCrossRef

Duffey BG, Pedro RN, Kriedberg C, et al. Lithogenic risk factors in the morbidly obese population. J Urol. 2008;179:1401–6.PubMedCrossRef

Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.PubMedCrossRef

Hocking MP, Duerson MC, O’Leary JP, et al. Jejunoileal bypass for morbid obesity. Late follow-up in 100 cases. N Engl J Med. 1983;308:995–9.PubMedCrossRef

Nelson WK, Houghton SG, Milliner DS, et al. Enteric hyperoxaluria, nephrolithiasis, and oxalate nephropathy: potentially serious and unappreciated complications of Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2005;1:481–5.PubMedCrossRef

Lipkin ME, Preminger GM. Imaging techniques for stone disease and methods for reducing radiation exposure. Urol Clin N Am. 2013;40:47–57.CrossRef

10.

Durrani O, Morrisroe S, Jackman S, et al. Analysis of stone disease in morbidly obese patients undergoing gastric bypass surgery. J Endourol. 2006;20:749–52.PubMedCrossRef

11.

Matlaga BR, Shore AD, Magnuson T, et al. Effect of gastric bypass surgery on kidney stone disease. J Urol. 2009;181:2573–77.PubMedCrossRef

12.

Mollerup CL, Vestergaard P, Frøkjaer VG, et al. Risk of renal stone events in primary hyperparathyroidism before and after parathyroid surgery: controlled retrospective follow up study. BMJ. 2002;325:807–11.PubMedCrossRef

13.

Asplin JR, Coe FL. Hyperoxaluria in kidney stone formers treated with modern bariatric surgery. J Urol. 2007;177:565–9.PubMedCrossRef

14.

Park AM, Storm DW, Fulmer BR, et al. A prospective study of risk factors for nephrolithiasis after Roux-en-Y gastric bypass surgery. J Urol. 2009;182:2334–9.PubMedCrossRef

15.

Duffey BG, Pedro RN, Makhlouf A, et al. Roux-en-Y gastric bypass is associated with early increased risk factors for development of calcium oxalate nephrolithiasis. J Am Coll Surg. 2008;206:1145–53.PubMedCrossRef

16.

Sinha MK, Collazo-Clavell ML, Rule A. Hyperoxaluric nephrolithiasis is a complication of Roux-en-Y gastric bypass surgery. Kidney Int. 2007;72:100–7.PubMedCrossRef

17.

Dobbins JW, Binder HJ. Effect of bile salts and fatty acids on the colonic absorption of oxalate. Gastroenterology. 1976;70:1096–100.PubMed

18.

Sidhu H, Schmidt ME, Cornelius JG, et al. Direct correlation between hyperoxaluria/oxalate stone disease and the absence of the gastrointestinal tract-dwelling bacteria Oxalobacter formigenes: possible prevention by gut recolonization or enzyme replacement therapy. J Am Soc Nephrol. 1999;10:S334–40.PubMed

19.

Maalouf NM, Tondapu P, Guth ES, et al. Hypocitraturia and hyperoxaluria after Roux-en-Y gastric bypass surgery. J Urol. 2010;183:1026–30.PubMedCrossRef

20.

Duffey BG, Alanee S, Pedro RN, et al. Hyperoxaluria is a long-term consequence of Roux-en-Y gastric bypass. A 2-year prospective longitudinal study. J Am Coll Surg. 2010;211:8–15.PubMedCrossRef

21.

Penniston KL, Kaplon DM, Gould JC, et al. Gastric band placement for obesity is not associated with increased urinary risk of urolithiasis compared to bypass. J Urol. 2009;182:2340–6.PubMedCrossRef

22.

Lee SC, Kim YJ, Kim TH, et al. Impact of obesity in patients with urolithiasis and its prognostic usefulness in stone recurrence. J Urol. 2008;179:570–4.PubMedCrossRef

23.

Zuckerman JM, Assimos DG. Hypocitraturia: pathophysiology and medical management. Rev Urol. 2009;11:134–44.PubMed

24.

Melnick JZ, Preisig PA, Haynes S, et al. Converting enzyme inhibition causes hypocitraturia independent of acidosis or hypokalemia. Kidney Int. 1998;54:1670–4.PubMedCrossRef

25.

Breslau NA, Brinkley L, Hill KD, et al. Relationship of animal protein-rich diet to kidney stone formation and calcium metabolism. J Clin Endocrinol Metab. 1988;66:140–6.PubMedCrossRef

26.

Patel BN, Passman CM, Fernandez A, et al. Prevalence of hyperoxaluria after bariatric surgery. J Urol. 2009;181:161–6.PubMedCrossRef

27.

Encinosa WE, Bernard DM, Chen CC, et al. Healthcare utilization and outcomes after bariatric surgery. Med Care. 2006;44:706–12.PubMedCrossRef

28.

Whitson JM, Stackhouse GB, Stoller ML. Hyperoxaluria after modern bariatric surgery: case series and literature review. Int Urol Nephrol. 2010;42:369–74.PubMedCrossRef

29.

Williams CP, Child DF, Hudson PR, et al. Why oral calcium supplements may reduce renal stone disease: report of a clinical pilot study. J Clin Pathol. 2001;54:54–62.PubMedCrossRef

Title: Urinary Evaluation After RYGBP: a Lithogenic Profile with Early Postoperative Increase in the Incidence of Urolithiasis
Authors: Antonio Carlos Valezi
Paulo Emilio Fuganti
Jorge Mali Junior
Vinicius Daher Delfino
Publication date: 01-10-2013
Publisher: Springer US
Published in: Obesity Surgery / Issue 10/2013
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-013-0916-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Urinary Evaluation After RYGBP: a Lithogenic Profile with Early Postoperative Increase in the Incidence of Urolithiasis

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 10/2013

Pulmonary Function Testing and Complications of Laparoscopic Bariatric Surgery

Experience of Excess Skin and Desire for Body Contouring Surgery in Post-bariatric Patients

Impact of Laparoscopic Sleeve Gastrectomy on Upper Gastrointestinal Symptoms

Fibrin Glue and Stents in the Treatment of Gastrojejunal Leaks after Laparoscopic Gastric Bypass: A Case Series and Review of the Literature

Prospective Longitudinal Assessment of Change in Health-Related Quality of Life After Adjustable Gastric Banding

Response to Basic Calculating Errors in Systematic Reviews