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Oxalate metabolism after intestinal bypass operations
B Nordenvall1, L Backman, L Larsson
1Dept. of Surgery, Karolinska Institute at Danderyd Hospital, Stockholm, Sweden.
Scandinavian Journal of Gastroenterology
|April 1, 1981
Summary
Patients with intestinal bypass surgery often develop hyperoxaluria and kidney stones. This study found that reduced dietary oxalate and total parenteral nutrition (TPN) significantly lowered urinary oxalate levels, suggesting hyperabsorption of dietary oxalate is the primary cause.
Area of Science:
- Nephrology
- Gastroenterology
- Nutritional Science
Background:
- Intestinal bypass surgery, particularly jejunoileostomy for morbid obesity, frequently leads to hyperoxaluria and kidney stones.
- Elevated urinary oxalate excretion is a common complication in these patients.
Purpose of the Study:
- To investigate urinary oxalate excretion in patients with jejunoileostomy during enteral and parenteral nutrition.
- To identify the primary cause of hyperoxaluria in patients following intestinal bypass operations.
Main Methods:
- Studied urinary oxalate excretion over 10-13 days in six patients on enteral and parenteral nutrition.
- Administered low-oxalate diets, total parenteral nutrition (TPN), and glycine loads.
- Compared oxalate excretion during different nutritional support methods.
Main Results:
- All patients exhibited higher-than-normal urinary oxalate on a regular diet.
- Oxalate excretion decreased with a low-oxalate diet and further reduced during TPN.
- Oxalate levels stabilized within 48 hours of TPN initiation, unaffected by glycine loading.
Conclusions:
- The primary cause of hyperoxaluria post-intestinal bypass is likely the hyperabsorption of dietary oxalate.
- Endogenous oxalate production appears to be normal in these patients.
- Total parenteral nutrition effectively reduces urinary oxalate levels.