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Abstract: PO2517

A Severe Case of Secondary Hyperoxaluria Successfully Treated

Session Information

Category: CKD (Non-Dialysis)

  • 2103 CKD (Non-Dialysis): Mechanisms

Authors

  • Zamora-Olivencia, Veronica, McGaw Medical Center of Northwestern University, Chicago, Illinois, United States
  • Ghossein, Cybele, McGaw Medical Center of Northwestern University, Chicago, Illinois, United States
Introduction

Bariatric Surgery for the treatment of obesity is categorized as either restrictive or malabsorptive. Malabsorption procedures are often used for long lasting weight loss in morbidly obese patients. The Biliopancreatic Diversion and Duodenal Switch (BPD/DS) is preferred for patients with more severe comorbidities as it provides best durability, minimal dumping syndrome and less dietary restriction. Malabsorption weight loss surgeries have been associated with AKI, CKD, nephrolithiasis and metabolic and nutritional derangements. Here we report a patient with history of BPD/DS with CKD due to hyperoxaluria.

Case Description

A 70-year-old female with history of morbid obesity since childhood, status post BPD/DS surgery in 2004 with persistent hypocalcemia, severe osteoporosis and newly recognized chronic kidney disease (CKD) was referred for nephrology consultation. Serum creatinine pre-surgery was 0.9. Her eGFR at the time of referral was 42cc/min and her urinalysis was without proteinuria. Renal Ultrasound was without nephrolithiasis. As part of her work up, a 24-hour urine collection for oxalate was obtained and revealed severe oxaluria at 168mg/day.
Patient’s medications included 4 grams a day of Calcium Citrate along with multiple other supplements. Patient admitted to non-compliance with her calcium supplements. After two months of strict compliance with low oxalate diet and calcium supplements a 24-hour urine collection showed improvement of oxaluria to 62 mg/day. Her renal function remains stable.

Discussion

Patients who undergo malabsorptive weight loss surgery are at risk for AKI , CKD and nephrolithiasis from hyperoxaluria . Kidney damage can continue years after the surgical procedure. Treatment involves low oxalate diet and aggressive oxalate binding with use of calcium supplements. Bariatric surgery reversal is the definitive treatment if conservative management fails. Bariatric patients should be referred promptly to a nephrologist if change in renal function is noted.