Digestive Disease Unit, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK.
Department of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK.
Nutrients. 2022 Apr 14;14(8):1646. doi: 10.3390/nu14081646.
Short gut syndrome can lead to type 3 intestinal failure, and nutrition and hydration can only be achieved with parenteral nutrition (PN). While this is a lifesaving intervention, it carries short- and long-term complications leading to complex comorbidities, including chronic kidney disease. Through a patient with devastating inflammatory bowel disease's journey, this review article illustrates the effect of short gut and PN on kidney function, focusing on secondary hyperoxaluria and acute precipitants of glomerular filtration. In extensive small bowel resections colon in continuity promotes fluid reabsorption and hydration but predisposes to hyperoxaluria and stone disease through the impaired gut permeability and fat absorption. It is fundamental, therefore, for dietary intervention to maintain nutrition and prevent clinical deterioration (i.e., sarcopenia) but also to limit the progression of renal stone disease. Adaptation of both enteral and parenteral nutrition needs to be individualised, keeping in consideration not only patient comorbidities (short gut and jejunostomy, cirrhosis secondary to PN) but also patients' wishes and lifestyle. A balanced multidisciplinary team (renal physician, gastroenterologist, dietician, clinical biochemist, pharmacist, etc.) plays a core role in managing complex patients, such as the one described in this review, to improve care and overall outcomes.
短肠综合征可导致 3 型肠衰竭，只能通过肠外营养 (PN) 来实现营养和水合作用。虽然这是一种救生干预措施，但它会带来短期和长期的并发症，导致复杂的合并症，包括慢性肾脏病。通过一位患有毁灭性炎症性肠病的患者的旅程，本文综述了短肠和 PN 对肾功能的影响，重点介绍了继发性高草酸尿症和肾小球滤过的急性诱发因素。在广泛的小肠切除术后，连续性结肠促进了液体的重吸收和水合作用，但通过受损的肠道通透性和脂肪吸收，易患高草酸尿症和结石病。因此，饮食干预对于维持营养和预防临床恶化（即肌肉减少症）至关重要，但也需要限制肾结石病的进展。需要个体化地调整肠内和肠外营养，不仅要考虑患者的合并症（短肠和空肠造口术、PN 引起的肝硬化），还要考虑患者的意愿和生活方式。一个平衡的多学科团队（肾脏医生、胃肠病学家、营养师、临床生化专家、药剂师等）在管理复杂患者（如本综述中描述的患者）方面发挥着核心作用，以改善护理和整体结果。
