Irreversible chronic renal failure following jejunoileal bypass
Michael B. Eckstein, M.D.
Department of Internal Medicine
Leonard H. Calabrese, D.O.
Department of Rheumatic and Immunologic Disease
Ray W. Gifford, M.D.
Department of Hypertension and Nephrology
Raymond R. Tubbs, D.O.
Division of Laboratory Medicine
Rafael Valenzuela, M.D.
Department of Immunopathology
Rafiq Hussain, M.D.
Hyperoxaluria and the presence of calcium oxalate stones are documented complications of intestinal bypass surgery. Renal failure secondary to interstitial calcium oxalate deposition is a rare complication of this procedure.1 To our knowledge, three cases have been reported.1–3 In two cases, intestinal continuity was reestablished and in one case urinary oxalate was reduced to normal and renal function was stabilized.2 We describe another case of renal failure following intestinal bypass surgery and the clinical course after restoration of bowel continuity.Case report
A 58-year-old white woman was first examined at The Cleveland Clinic Foundation in March 1970 with mild essential hypertension, exogenous obesity, 111 kg (245 pounds), 157 cm (5 feet, 2 inches), and mild Type IV hyperlipoproteinemia. Renal evaluation including intravenous pyelogram, creatinine, blood urea nitrogen (BUN), and urinalysis were within normal limits. In March 1974, the patient underwent an end-to-side jejunoileal bypass with incidental appendectomy at another hospital. She weighed approximately 114 kg (250 pounds). After surgery she began to experience hypogastric cramps, diarrhea (four loose stools per day), nausea, vomiting, and weakness, which continued unabated until she was seen at the Cleveland Clinic in September 1976. Over a 2½-year period she steadily lost weight and finally reached a plateau of 59 kg (130 pounds). On September 28, 1975, she underwent cholecystectomy for chronic cholecystitis and cholelithiasis at another hospital. Her BUN was 35 mg/dl (Table). Except for a trace of protein, urinalysis was within normal limits. On February 6, 1976, the patient was again examined at . . .