Oxalate nephropathy complicating Roux-en-Y Gastric Bypass: an underrecognized cause of irreversible renal failure.
OBJECTIVE
The most common bariatric surgery is Roux-en-Y gastric bypass (RYGB), which has been associated with hyperoxaluria and nephrolithiasis. We report a novel association of RYGB with renal insufficiency as a result of oxalate nephropathy.


METHODS
Eleven cases of oxalate nephropathy after RYGB were identified from the Renal Pathology Laboratory of Columbia University. The clinical features, pathologic findings, and outcomes are described.


RESULTS
Patients were predominantly white (72.7%) with a mean age of 61.3 yr. Indications for RYGB included morbid obesity (eight patients) and reconstruction after total gastrectomy for gastric cancer (three patients). All 11 patients had a history of hypertension, and 9 were diabetic. Patients presented with acute renal failure, often superimposed on mild chronic renal insufficiency (n = 7), at a median of 12 mo after RYGB. The mean creatinine at baseline, at discovery of acute renal failure, and at biopsy was 1.5, 5.0, and 6.5 mg/dl, respectively. Renal biopsies revealed diffuse tubular degenerative changes, abundant tubular calcium oxalate deposits, and varying degrees of tubulointerstitial scarring. In addition, seven biopsies had underlying diabetic glomerulosclerosis and two had glomerulosclerosis attributable to obesity and hypertension. Eight of 11 patients rapidly progressed to ESRD and required hemodialysis at a mean of 3.2 wk after renal biopsy. The remaining three patients were left with significant chronic kidney disease.


CONCLUSIONS
Oxalate nephropathy is an underrecognized complication of RYGB and typically results in rapid progression to ESRD. Patients with pre-existing renal disease may be at higher risk for this complication.
Nasr
Samih H
SH
Department of Pathology, Columbia University, College of Physicians & Surgeons, New York, NY 10032, USA. sn386@columbia.edu
D'Agati
Vivette D
VD
Said
Samar M
SM
Stokes
Michael B
MB
Largoza
Maria V
MV
Radhakrishnan
Jai
J
Markowitz
Glen S
GS
D000368:Aged; D002129:Calcium Oxalate / Q000378:metabolism*; D003404:Creatinine / Q000378:metabolism; D018450:Disease Progression; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology* / Q000378:metabolism / Q000473:pathology / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D007678:Kidney Glomerulus / Q000378:metabolism / Q000473:pathology; D007684:Kidney Tubules / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D006435:Renal Dialysis; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000601:surgery*
D002129:Calcium Oxalate; D003404:Creatinine