Hyperoxaluria and Nephrolithiasis After Gastric Bypass Surgery for Obesity

肥胖胃绕道手术后高草酸尿和肾结石

• 批准号: 7456371
• 负责人: RAJIV KUMAR
• 金额: $ 18.51万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-07-01 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7456371
• 关键词: Affect; Bacteria; Biochemical; Body Weight decreased; Calcium Oxalate; Calculi; Chemicals; Clinical Research; Condition; Data; Evaluation; Frequencies; Functional disorder; Future; Gastric Bypass; Goals; Grant; Hyperoxaluria; Impaired Renal Function; Incidence; Intervention Trial; Intestines; Kidney; Kidney Calculi; Malabsorption Syndromes; Measurement; Measures; Metabolic; Morbidity - disease rate; Nephrocalcinosis; Nephrolithiasis; Numbers; Obesity; Operative Surgical Procedures; Oral Administration; Outcome; Oxalates; Oxalobacter formigenes; Patients; Physicians; Prevalence; Procedures; Rate; Renal function; Research; Research Project Grants; Risk Factors; Secondary to; Severities; Testing; Therapeutic Intervention; United States National Institutes of Health; Urine; Urologic Diseases; absorption; bariatric surgery; base; design; insight; prevent; response; symposium

DESCRIPTION (provided by applicant): Patients often develop nephrolithiasis after gastric bypass surgery for medically-complicated obesity. We have shown in a limited number of patients that metabolic risk factors for stones such as hyperoxaluria, hypocitraturia, and hypocalciuria are common 1 year after gastric bypass procedures, even without clinically apparent nephrolithiasis. The goals of this application are to examine the prevalence and mechanisms of hyperoxaluria and nephrolithiasis in patients after Roux-en-Y Gastric Bypass (RYGB) operations for medically- complicated obesity. Information obtained during this grant period will allow us to define the scope of the problem and acquire information for appropriate larger-scale trials to prevent nephrolithiasis, nephrocalcinosis and possibly renal dysfunction in patients who are increasingly being treated for medically-complicated obesity with RYGB. Our hypothesis is that hyperoxaluria frequently develops in patients after RYGB operations for medically-complicated obesity, and this metabolic abnormality often results in the occurrence of nephrolithiasis. Nephrocalcinosis and impaired renal function are potential and even more serious complications of RYGB surgery. We hypothesize that hyperoxaluria observed in these patients is secondary to the hyper-absorption of oxalate from the bowel. Our specific aims are: 1) To estimate the incidence and prevalence of nephrolithiasis, nephrocalcinosis and impaired renal function in a group of 100 patients undergoing RYGB operations, and to compare the findings in these operated patients with those seen in 30 non-operated obese controls. The patients will undergo extensive biochemical and radiological evaluation for nephrolithiasis prior to the RYGB operation for medically-complicated obesity, and again at 6 and 12 months after the operation. 2) To determine the mechanism by which hyperoxaluria occurs in patients after RYGB procedures for medically complicated obesity. To develop insight into potential mechanisms that could be targets of intervention trials, we will assess intestinal oxalate absorption before and after RYGB by oral administration of 13C oxalate and the measurement of excreted 13 C oxalate in the urine. We will determine whether such patients have fatty malabsorption. We will assess whether these patients are colonized by the oxalate-degrading bacterium Oxalobacter formigenes prior to the RYGB procedure, and if the patients' colonization status changes after the procedure and contributes to the severity of hyperoxaluria. The significance of our study is that it will determine the prevalence of hyperoxaluria, nephrolithiasis and loss of renal function in patients following RYGB surgery and it will suggest mechanisms by which these complications occur. Based on these findings we will be able to define rational interventions and therapies that can be used to prevent such complications of RYGB surgery. Gastric bypass operations are being performed at an increasing rate in patients with obesity because of the beneficial outcomes associated with weight loss. There is evidence that patients form kidney stones and suffer reductions in kidney function as a result of the surgery. We will determine how commonly stones and chemical risk factors for stones occur in patients who have had gastric bypass surgery. Finally, we will study why these complications occur and we will develop ways in which to prevent kidney stones and loss of kidney function after gastric bypass surgery.

描述（由申请人提供）：患者在因医学并发症性肥胖而进行胃绕道手术后经常出现肾结石。我们在有限数量的患者中发现，即使没有临床上明显的肾结石，高草酸尿、低柠檬酸尿和低钙尿等结石代谢危险因素在胃绕道手术后 1 年内也很常见。该应用的目的是检查因医学复杂性肥胖而进行 Roux-en-Y 胃旁路手术 (RYGB) 后患者中高草酸尿症和肾结石的患病率和机制。在此资助期内获得的信息将使我们能够确定问题的范围，并为适当的更大规模的试验获取信息，以预防肾结石、肾钙质沉着症和可能的肾功能不全，这些患者越来越多地接受 RYGB 治疗医学并发症性肥胖患者。我们的假设是，因医学并发症性肥胖而进行 RYGB 手术后的患者经常出现高草酸尿症，这种代谢异常往往会导致肾结石的发生。肾钙质沉着症和肾功能受损是 RYGB 手术潜在甚至更严重的并发症。我们假设这些患者中观察到的高草酸尿症继发于肠道对草酸盐的过度吸收。我们的具体目标是：1) 估计 100 名接受 RYGB 手术的患者中肾结石、肾钙质沉着症和肾功能受损的发病率和患病率，并将这些手术患者的结果与 30 名未手术的肥胖对照患者的结果进行比较。在针对医疗并发症性肥胖进行 RYGB 手术之前，以及在手术后 6 个月和 12 个月时，患者将接受广泛的肾结石生化和放射学评估。 2) 确定医学复杂性肥胖患者在 RYGB 手术后发生高草酸尿的机制。为了深入了解可能成为干预试验目标的潜在机制，我们将通过口服 13 C 草酸盐和测量尿液中排出的 13 C 草酸盐来评估 RYGB 前后肠道草酸盐的吸收情况。我们将确定此类患者是否患有脂肪吸收不良。我们将在 RYGB 手术前评估这些患者是否被草酸盐降解细菌福氏草酸杆菌定植，以及患者的定植状态在手术后是否发生变化并导致高草酸尿症的严重程度。我们研究的意义在于，它将确定 RYGB 手术后患者高草酸尿症、肾结石和肾功能丧失的患病率，并提出这些并发症发生的机制。基于这些发现，我们将能够确定合理的干预措施和疗法，用于预防 RYGB 手术的此类并发症。由于与减肥相关的有益结果，肥胖患者进行胃绕道手术的比例越来越高。有证据表明，手术导致患者形成肾结石并导致肾功能下降。我们将确定接受胃绕道手术的患者中结石发生的频率以及结石的化学危险因素。最后，我们将研究这些并发症发生的原因，并开发预防胃绕道手术后肾结石和肾功能丧失的方法。

项目成果

Comparison between immunoturbidimetry, size-exclusion chromatography, and LC-MS to quantify urinary albumin.

比较免疫比浊法、尺寸排阻色谱法和 LC-MS 定量尿白蛋白的方法。

• DOI: 10.1373/clinchem.2008.107508
• 发表时间: 2008-09-01
• 期刊: Clinical chemistry
• 影响因子: 9.3
• 作者: Aisha Shaikh;Jesse C. Seegmiller;T. M. Borl;B. Burns;P. Ladwig;Ravinder J Singh;R. Kumar;T. Lars
• 通讯作者: T. Lars

Gastric bypass surgery and measured and estimated GFR in women.

胃绕道手术以及女性 GFR 的测量和估计。

• 发表时间: 2014-10
• 作者: Lieske, John C;Collazo;Sarr, Michael G;Rule, Andrew D;Bergstralh, Eric J;Kumar, Rajiv
• 通讯作者: Kumar, Rajiv

Mechanisms of renal phosphate loss in liver resection-associated hypophosphatemia.

肝切除相关低磷血症中肾磷丢失的机制。

• 发表时间: 2009-05
• 影响因子: 9
• 作者: Nafidi, Otmane;Lapointe, Real W;Lepage, Raymond;Kumar, Rajiv;D'Amour, Pierre
• 通讯作者: D'Amour, Pierre

KDOQI US commentary on the 2009 KDIGO Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of CKD-Mineral and Bone Disorder (CKD-MBD).

KDOQI 美国对 2009 年 KDIGO CKD 矿物质和骨疾病 (CKD-MBD) 诊断、评估和治疗临床实践指南的评论。

• DOI: 10.1053/j.ajkd.2010.02.340
• 发表时间: 2010-05-01
• 期刊: American journal of kidney diseases : the official journal of the National Kidney Foundation
• 作者: K. Uhlig;J. Berns;B. Kestenbaum;Raj Kumar;M. Leonard;K. Martin;S. Sprague;Stanley Goldfarb
• 通讯作者: Stanley Goldfarb

Gastric bypass procedures and renal calculi--how should we counsel patients and bariatric surgeons?

胃绕道手术和肾结石——我们应该如何为患者和减肥外科医生提供咨询？

• 发表时间: 2009-11
• 作者: Lieske JC