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Stone formation and management after bariatric surgery.
Sarah Tarplin1, Vishnu Ganesan1, Manoj Monga1
1Cleveland Clinic Foundation, Stevan Streem Center for Endourology &Stone Disease, Glickman Urological &Kidney Institute, 9500 Euclid Avenue, Mail Code Q9-100, Cleveland, OH 44195, USA.
Nature Reviews. Urology
|April 9, 2015
Summary
Obesity increases kidney stone risk. Bariatric surgery further elevates this risk due to altered oxalate absorption and urinary changes, necessitating specific dietary and supplement interventions for prevention.
Area of Science:
- Nephrology
- Metabolic Medicine
- Gastroenterology
Background:
- Obesity is a major health issue linked to increased nephrolithiasis (kidney stones), especially in women.
- Pathophysiology involves insulin resistance, diet, and lithogenic urine profiles, leading to uric acid and calcium oxalate stones.
- Bariatric surgery, while managing obesity comorbidities, paradoxically doubles the risk of nephrolithiasis.
Purpose of the Study:
- To elucidate the mechanisms behind increased nephrolithiasis risk post-bariatric surgery.
- To identify characteristic urinary parameters in bariatric surgery patients related to stone formation.
- To outline preventive strategies for kidney stones in this population.
Main Methods:
- Review of controlled studies on bariatric surgery outcomes.
- Analysis of characteristic 24-hour urine parameters in post-bariatric surgery patients.
- Evaluation of existing and potential therapeutic interventions.
Main Results:
- Bariatric surgery leads to fat malabsorption, increasing gut oxalate hyperabsorption and permeability.
- Patients exhibit low urine volume, low urinary pH, hypocitraturia, hyperoxaluria, and hyperuricosuria.
- Dietary modifications (low oxalate/sodium, high fluids) and supplements (calcium citrate, potassium citrate) are critical.
Conclusions:
- Bariatric surgery significantly increases nephrolithiasis risk through specific metabolic and urinary changes.
- Dietary management and supplementation (potassium citrate, calcium citrate) are essential for prevention.
- Further research on pyridoxine and probiotics for hyperoxaluria in bariatric patients is warranted.
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