Effect of preoperative metabolic profiling to reduce the risk of kidney stones after bariatric surgery in patients with a history of stone formation

Published:December 11, 2022DOI:


      • Roux-en-Y gastric bypass (RYGB) in stone formers shows an increase in oxalate excretion in 50% of patients.
      • Sleeve gastrectomy (SG) in stone formers had no adverse effects on urinary oxalate and citrate excretion.
      • Both show favorable effects on sodium, calcium, uric acid, and phosphate excretion.
      • Metabolic profiling helps to select the best bariatric procedure in stone formers.



      Roux-en-Y gastric bypass (RYGB) is associated with an increased risk of kidney stone formation. This is not observed after sleeve gastrectomy (SG).


      Aim of this study was to assess whether preoperative metabolic profiling is helpful in selecting the most optimal bariatric procedure for patients with a kidney stone history.


      General hospital, the Netherlands.


      Patients with a kidney stone history and in the run up to bariatric surgery were screened with non-contrast abdominal computed tomography (CT), serum profiling, and 24-hour urine analysis. Those with stones on radiologic imaging and/or high preoperative urinary oxalate were advised to undergo SG instead of RYGB. Pre- and postoperative urine and serum profile differences between both groups were evaluated retrospectively.


      Postoperatively, RYGB (N = 28, M:F = 8:20) was associated with a 23.5% reduction in urinary volume, a 85% increase in urinary oxalate excretion with a 230% increase in calcium oxalate (CaOx) supersaturation and a 62% decrease in urinary citrate. Although SG (N = 30, M:F = 12:18) was also associated with a reduction in urinary volume, it had no adverse effects on urinary oxalate and citrate excretion, nor on calcium oxalate supersaturation (CaOx-SS). Both RYGB and SG showed favorable effects on postoperative sodium, calcium, uric acid, and phosphate excretion.


      This study indicates that preoperative metabolic profiling is important to select the optimal bariatric procedure in patients with an a priori increased risk of kidney stone development. These patients should be strongly encouraged to undergo SG instead of RYGB to prevent progressive or recurrent kidney stone disease.


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        • Aune D.
        • Mahamat-Saleh Y.
        • Norat T.
        • Riboli E.
        Body fatness, diabetes, physical activity and risk of kidney stones: a systematic review and meta-analysis of cohort studies.
        Eur J Epidemiol. 2018; 33: 1033-1047
        • Matlaga B.R.
        • Shore A.D.
        • Magnuson T.
        • Clark J.M.
        • Johns R.
        • Makary M.A.
        Effect of gastric bypass surgery on kidney stone disease.
        J Urol. 2009; 181: 2573-2577
        • Lieske J.C.
        • Mehta R.A.
        • Milliner D.S.
        • Rule A.D.
        • Bergstralh E.J.
        • Sarr M.G.
        Kidney stones are common after bariatric surgery.
        Kidney Int. 2015; 87: 839-845
        • Semins M.J.
        • Asplin J.R.
        • Steele K.
        • et al.
        The effect of restrictive bariatric surgery on urinary stone risk factors.
        Urology. 2010; 76: 826-829
        • Chen T.
        • Godebu E.
        • Horgan S.
        • Mirheydar H.S.
        • Sur R.L.
        The effect of restrictive bariatric surgery on urolithiasis.
        J Endourol. 2013; 27: 242-244
        • Semins M.J.
        • Matlaga B.R.
        • Shore A.D.
        • et al.
        The effect of gastric banding on kidney stone disease.
        Urology. 2009; 74: 746-750
        • Nelson W.K.
        • Houghton S.G.
        • Milliner D.S.
        • et al.
        Enteric hyperoxaluria, nephrolithiasis, and oxalate nephropathy: potentially serious and unappreciated complications of Roux-en-Y gastric bypass.
        Surg Obes Relat Dis. 2005; 1: 481-485
        • Patel B.N.
        • Passman C.M.
        • Fernandez A.
        • et al.
        Prevalence of hyperoxaluria after bariatric surgery.
        J Urol. 2009; 181: 161-166
        • Penniston K.L.
        • Kaplon D.M.
        • Gould J.C.
        • Nakada S.Y.
        Gastric band placement for obesity is not associated with increased urinary risk of urolithiasis compared to bypass.
        J Urol. 2009; 182: 2340-2346
        • Maalouf N.M.
        • Tondapu P.
        • Guth E.S.
        • Livingston E.H.
        • Sakhaee K.
        Hypocitraturia and hyperoxaluria after Roux-en-Y gastric bypass surgery.
        J Urol. 2010; 183: 1026-1030
        • Froeder L.
        • Arasaki C.H.
        • Malheiros C.A.
        • Baxmann A.C.
        • Heilberg I.P.
        Response to dietary oxalate after bariatric surgery.
        Clin J Am Soc Nephrol. 2012; 7: 2033-2040
        • Park A.M.
        • Storm D.W.
        • Fulmer B.R.
        • Still C.D.
        • Wood G.C.
        • Hartle 2nd, J.E.
        A prospective study of risk factors for nephrolithiasis after Roux-en-Y gastric bypass surgery.
        J Urol. 2009; 182: 2334-2339
        • Duffey B.G.
        • Alanee S.
        • Pedro R.N.
        • et al.
        Hyperoxaluria is a long-term consequence of Roux-en-Y gastric bypass: a 2-year prospective longitudinal study.
        J Am Coll Surg. 2010; 211: 8-15
        • Kumar R.
        • Lieske J.C.
        • Collazo-Clavell M.L.
        • et al.
        Fat malabsorption and increased intestinal oxalate absorption are common after Roux-en-Y gastric bypass surgery.
        Surgery. 2011; 149: 654-661
        • Wu J.N.
        • Craig J.
        • Chamie K.
        • Asplin J.
        • Ali M.R.
        • Low R.K.
        Urolithiasis risk factors in the bariatric population undergoing gastric bypass surgery.
        Surg Obes Relat Dis. 2013; 9: 83-87
        • Agrawal V.
        • Liu X.J.
        • Campfield T.
        • Romanelli J.
        • Enrique Silva J.
        • Braden G.L.
        Calcium oxalate supersaturation increases early after Roux-en-Y gastric bypass.
        Surg Obes Relat Dis. 2014; 10: 88-94
        • Valezi A.C.
        • Fuganti P.E.
        • Junior J.M.
        • Delfino V.D.
        Urinary evaluation after RYGBP: a lithogenic profile with early postoperative increase in the incidence of urolithiasis.
        Obes Surg. 2013; 23: 1575-1580
        • Hutchinson R.
        • Parker A.S.
        • Arnold M.
        • et al.
        Prospective evaluation of 24-hour urine profiles following bariatric surgery in a modern comprehensive care bariatric clinic.
        Clin Nephrol. 2014; 81: 331-337
        • Asplin J.R.
        • Coe F.L.
        Hyperoxaluria in kidney stone formers treated with modern bariatric surgery.
        J Urol. 2007; 177: 565-569
        • Pang R.
        • Linnes M.P.
        • O’Connor H.M.
        • Li X.
        • Bergstralh E.
        • Lieske J.C.
        Controlled metabolic diet reduces calcium oxalate supersaturation but not oxalate excretion after bariatric surgery.
        Urology. 2012; 80: 250-254
        • Uy M.
        • Di Lena R.
        • Hoogenes J.
        • et al.
        Bariatric surgery in patients with a history of nephrolithiasis: 24-h urine profiles and radiographic changes after Roux-en-Y gastric bypass versus sleeve gastrectomy.
        Obes Surg. 2021; 31: 1673-1679
        • Mechanick J.I.
        • Apovian C.
        • Brethauer S.
        • et al.
        Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures – 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, the Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists.
        Surg Obes Relat Dis. 2020; 16: 175-247
      1. International federation for the surgery of obesity and metabolic disorders (IFSO). Selection criteria. [Internet].
        (Available from:)
        Date accessed: June 1, 2021
        • Homan J.
        • Boerboom A.
        • Aarts E.
        • et al.
        A longer biliopancreatic limb in Roux-en-Y gastric bypass improves weight loss in the first years after surgery: results of a randomized controlled trial.
        Obes Surg. 2018; 28: 3744-3755
      2. IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version Armonk, NY: IBM Corp.

        • Ogawa Y.
        Modification of estimation of the urinary ion-activity products of calcium oxalate and calcium phosphate.
        Hinyokika Kiyo. 1993; 39: 407-411
        • Ogawa Y.
        • Hatano T.
        Comparison of the Equil2 program and other methods for estimating the ion-activity product of urinary calcium oxalate: a new simplified method is proposed.
        Int J Urol. 1996; 3: 383-385
        • Curhan G.C.
        • Taylor E.N.
        24-h uric acid excretion and the risk of kidney stones.
        Kidney Int. 2008; 73: 489-496
        • Melissas J.
        • Leventi A.
        • Klinaki I.
        • et al.
        Alterations of global gastrointestinal motility after sleeve gastrectomy: a prospective study.
        Ann Surg. 2013; 258: 976-982
        • Pak C.Y.C.
        • Poindexter J.R.
        • Adams-Huet B.
        • Pearle M.S.
        Predictive value of kidney stone composition in the detection of metabolic abnormalities.
        Am J Med. 2003; 115: 26-32
        • Sakhaee K.
        • Poindexter J.
        • Aguirre C.
        The effects of bariatric surgery on bone and nephrolithiasis.
        Bone. 2016; 84: 1-8
        • Dobbins J.W.
        • Binder H.J.
        Effect of bile salts and fatty acids on the colonic absorption of oxalate.
        Gastroenterology. 1976; 70: 1096-1100
        • Aspenstrom-Fagerlund B.
        • Ring L.
        • Aspenstrom P.
        • Tallkvist J.
        • Ilback N.-G.
        • Glynn A.W.
        Oleic acid and docosahexaenoic acid cause an increase in the paracellular absorption of hydrophilic compounds in an experimental model of human absorptive enterocytes.
        Toxicology. 2007; 237: 12-23
        • Hatch M.
        • Freel R.W.
        A human strain of Oxalobacter (HC-1) promotes enteric oxalate secretion in the small intestine of mice and reduces urinary oxalate excretion.
        Urolithiasis. 2013; 41: 379-384
        • Canales B.K.
        • Hatch M.
        Oxalobacter formigenes colonization normalizes oxalate excretion in a gastric bypass model of hyperoxaluria.
        Surg Obes Relat Dis. 2017; 13: 1152-1158
        • Requarth J.A.
        • Burchard K.W.
        • Colacchio T.A.
        • et al.
        Long-term morbidity following jejunoileal bypass. The continuing potential need for surgical reversal.
        Arch Surg. 1995; 130: 318
        • Nasr S.H.
        • D’Agati V.D.
        • Said S.M.
        • et al.
        Oxalate nephropathy complicating Roux-en Y gastric bypass: an underrecognized cause of irreversible renal failure.
        Clin J Am Soc Nephrol. 2008; 3: 1676-1683

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