Division of Nephrology, University of Leipzig Medical Center, Leipzig, Germany.
Department of Nephrology and Internal Intensive Care Medicine, Charité University, Berlin, Germany.
Sci Rep. 2023 Jun 3;13(1):9029. doi: 10.1038/s41598-023-35941-8.
The risk of enteric hyperoxaluria is significantly increased after malabsorptive bariatric surgery (MBS). However, its underlying determinants are only poorly characterized. In this case-control study, we aimed at identifying clinical and genetic factors to dissect their individual contributions to the development of post-surgical hyperoxaluria. We determined the prevalence of hyperoxaluria and nephrolithiasis after MBS by 24-h urine samples and clinical questionnaires at our obesity center. Both hyperoxaluric and non-hyperoxaluric patients were screened for sequence variations in known and candidate genes implicated in hyperoxaluria (AGXT, GRHPR, HOGA1, SLC26A1, SLC26A6, SLC26A7) by targeted next generation sequencing (tNGS). The cohort comprised 67 patients, 49 females (73%) and 18 males (27%). While hyperoxaluria was found in 29 patients (43%), only one patient reported postprocedural nephrolithiasis within 41 months of follow-up. Upon tNGS, we did not find a difference regarding the burden of (rare) variants between hyperoxaluric and non-hyperoxaluric patients. However, patients with hyperoxaluria showed significantly greater weight loss accompanied by markers of intestinal malabsorption compared to non-hyperoxaluric controls. While enteric hyperoxaluria is very common after MBS, genetic variation of known hyperoxaluria genes contributes little to its pathogenesis. In contrast, the degree of postsurgical weight loss and levels of malabsorption parameters may allow for predicting the risk of enteric hyperoxaluria and consecutive kidney stone formation.
肠源性高草酸尿症的风险在吸收不良性减重手术后(MBS)显著增加。然而,其潜在的决定因素仅被部分描述。在这项病例对照研究中,我们旨在确定临床和遗传因素,以剖析它们对术后高草酸尿症发展的各自贡献。我们通过我们肥胖中心的 24 小时尿液样本和临床问卷来确定 MBS 后高草酸尿症和肾结石的患病率。我们对高草酸尿症和非高草酸尿症患者进行了已知和候选基因中与高草酸尿症相关的序列变异(AGXT、GRHPR、HOGA1、SLC26A1、SLC26A6、SLC26A7)的筛选,方法是通过靶向下一代测序(tNGS)。该队列包括 67 名患者,其中 49 名女性(73%)和 18 名男性(27%)。虽然在 29 名患者(43%)中发现了高草酸尿症,但在 41 个月的随访中只有 1 名患者报告术后肾结石形成。通过 tNGS,我们在高草酸尿症和非高草酸尿症患者之间的(罕见)变异负担方面没有发现差异。然而,与非高草酸尿症对照组相比,高草酸尿症患者的体重减轻幅度更大,并伴有肠道吸收不良的标志物。尽管肠源性高草酸尿症在 MBS 后非常常见,但已知高草酸尿症基因的遗传变异对其发病机制的贡献很小。相比之下,术后体重减轻的程度和吸收不良参数的水平可能可以预测肠源性高草酸尿症和随后的肾结石形成的风险。