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Abstract: FR-PO1012

Bariatric Surgery: Benefits that May Harm, a Cause of Rapid Deterioration of Kidney Function

Session Information

Category: CKD (Non-Dialysis)

  • 2303 CKD (Non-Dialysis): Mechanisms

Authors

  • Morales Lopez, Enrique Fleuvier, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico City, Mexico
  • Diaz Garcia, Juan Daniel, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico City, Mexico
  • Rosillo-Salgado, Ydris Zelim, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico City, Mexico
  • Yama Estrella, Martin Benjamin, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico City, Mexico
  • Hernandez Copca, Francisco Javier, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico City, Mexico
  • Velasco Garcia Lascurain, Francisco, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico City, Mexico
  • Ortega, Jose Luis, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico City, Mexico
  • Ulloa Galvan, Victor Manuel, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico City, Mexico
  • Alamilla-Sanchez, Mario, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico City, Mexico
  • Ramírez Garcia, Guillermo Eduardo, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico City, Mexico
  • Ramirez, Irving Gaston, Centro Medico Nacional 20 de Noviembre, Mexico City, Mexico City, Mexico
Introduction

Secondary hyperoxaluria in post-bariatric surgery patients is well documented. The en y de roux and gastric band bypass techniques are the most closely related. A frequent complication is renal lithiasis with progressive loss of renal function.

Case Description

63-year-old female, history of gastric bypass due to morbid obesity (150 to 90 kg), DM 2 difficult to control. He was admitted to nephrology due to rapidly progressive deterioration of function, basal creatinine 1.12 mg/dl, on admission with 4.5 mg/dl, C3 49 mg/dl, C4 17 mg/dl (low) ANA 1:80. Renal biopsy: with 2 silver + acellular nodules, interstitium with patches of fibrosis and tubular atrophy, infiltrate of lymphocytes, polymorphonuclear cells, and eosinophils. Birefringent intratubular calcifications, loss of brush border. negative IFI

Discussion

Lithogenicity from bariatric surgery is multifactorial with mechanisms: (1) calcium saponification as a result of fat malabsorption reduces calcium-oxalate binding. (2) Increased bile salts in the colon (as a result of their decreased absorption in proximal portions of the intestine) increased mucosal permeability to oxalate (3) reduced colonization by oxalobacter formigenes, especially with the use of beta-lactams. Conclusions: serum and urinary metabolic screening of patients after bariatric surgery would allow an increase in the early detection of patients at high risk of enteric hyperoxaluria. once the lithiasic disease is detected, dietary adjustments and avoiding the indiscriminate use of antibiotics are essential to prevent the progressive deterioration of renal function.