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Bariatric Surgery and Stone Risk

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Nutritional and Medical Management of Kidney Stones

Part of the book series: Nutrition and Health ((NH))

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Abstract

Bariatric surgery patients represent a diverse group of individuals often with multiple coexisting medical problems. Nephrolithiasis has been shown to occur at variable rates relative to the specific procedure that individuals have undergone. The following chapter discusses stone risk factors, biochemical changes, and treatment strategies available for postoperative bariatric surgery patients.

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Abbreviations

BMI:

Body mass index

BPD/DS:

Biliopancreatic diversion with duodenal switch

CaOx:

Calcium oxalate GI Gastrointestinal

LAGB:

Laparoscopic adjustable gastric banding

PCC:

Potassium citrate and calcium citrate

RYGB:

Laparoscopic Roux-en-Y gastric bypass

SG:

Laparoscopic sleeve gastrectomy

SS:

Supersaturation

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Author information

Authors and Affiliations

  1. Tufts Medical Center, Weight and Wellness Center, Boston, MA, USA

    Jillian Reece

  2. Mount Auburn Hospital, Waltham, MA, USA

    R. Wesley Vosburg

  3. Tufts Medical Center, Boston, MA, USA

    Nitender Goyal

Authors
  1. Jillian Reece
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  2. R. Wesley Vosburg
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  3. Nitender Goyal
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Corresponding author

Correspondence to Jillian Reece .

Editor information

Editors and Affiliations

  1. Department of Nephrology, Harvard Vanguard Medical Associates, Boston, MA, USA

    Haewook Han

  2. Division of Nephrology, Newton-Wellesley Hospital, Newton, MA, USA

    Walter P. Mutter

  3. Department of Nephrology, Harvard Vanguard Medical Associates, Boston, MA, USA

    Samer Nasser

Patient Case

Patient Case

  • HPI: 80-year-old man, former marine and retired airline pilot who presents to the clinic with complaints of 6/10 lower back pain that radiates to his right side and lower abdomen and one episode of vomiting with persistent nausea for the last 24 hours. He has been drinking mostly liquids since yesterday and took ibuprofen to relieve his pain however found that it continued.

  • Medical history: Hypertension, hyperlipidemia, obesity, single kidney stone in 2014 s/p lithotripsy, depression, migraine headaches, vitamin D deficiency.

  • Surgical history: RYGB.

  • Medications: Lisinopril, simvastatin, bupropion, sumatriptan, ibuprofen prn, complete multivitamin with iron once a day, vitamin B12 500 mcg a day, vitamin D 2000 units a day, calcium carbonate 400 mg a day.

Ht: 68”   Wt: 206 lbs   BMI: 31.4

24-hour dietary recall

  • Take medications regularly in morning and evening.

  • One cup regular coffee with cream, three cups decaf coffee w/cream.

  • 8–10 oz. water.

  • 5–6 saltine crackers.

  • Slice of toast with butter.

Eating habits

  • Eating frequency: three meals/day with occasional snack in the afternoon

  • Protein choices: poultry, beef, pork, eggs, and cheese. No longer using protein supplements

  • Eating out: 4–6×/week; pizza and salad, chicken parmesan with pasta and marinara sauce, 6 oz. steak with mashed potatoes and spinach, eggs with bacon, potatoes, and toast

  • Fluid intake: regular and decaf coffee with cream, occasional water, or juice. No alcohol or milk

The patient was sent for a CT scan after initial visit and was found to have a kidney stone. He underwent lithotripsy, and stone analysis showed calcium oxalate.

Looking back at CM’s history, what were some of his risk factors for stone development?

  • Hx RYGB with previous kidney stone.

  • Low fluid intake – Perhaps learned this as a pilot; drinking mostly coffee

  • Frequent meal out with likely high sodium and fat content, potential fat malabsorption

  • Inadequate calcium supplementation – 400 mg calcium carbonate vs 1200–1500 mg calcium citrate recommended

What lifestyle recommendations will you discuss with the patient?

  • Increase fluid intake to at least 2.5 liters a day, and devise a consistent hydration routine.

  • Reduce sodium intake to <2300 mg/day, more cooking at home.

  • Monitor oxalate content in foods and limit concentrated sources.

  • Consider decrease in animal protein sources and increase calcium-containing foods such as yogurt or whey protein supplement.

  • Change calcium carbonate to calcium citrate, and increase to 1200 mg a day; take with meals.

What medical evaluation and treatment recommendations will you discuss with the patient?

  • Obtain 24-hour urinary chemistry profile before dietary modification and 6 weeks after.

  • His baseline 24-hour urinary chemistry profile showed high urinary oxalate, low urinary citrate, high CaOx SS, and low urine volume.

  • Start potassium citrate 20 mEq three times a day if the patient continues to have low urinary citrate and high CaOx SS after initial dietary and lifestyle modification.

  • Repeat 24 urinary chemistry profile 4–8 weeks after initiating potassium citrate.

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Reece, J., Vosburg, R.W., Goyal, N. (2019). Bariatric Surgery and Stone Risk. In: Han, H., Mutter, W., Nasser, S. (eds) Nutritional and Medical Management of Kidney Stones. Nutrition and Health. Humana, Cham. https://doi.org/10.1007/978-3-030-15534-6_15

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  • DOI: https://doi.org/10.1007/978-3-030-15534-6_15

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  • Publisher Name: Humana, Cham

  • Print ISBN: 978-3-030-15533-9

  • Online ISBN: 978-3-030-15534-6

  • eBook Packages: MedicineMedicine (R0)

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