In short bowel syndrome (SBS) treated with parenteral nutrition (PN), multiple complications can occur. The etiology of kidney stones may be linked to the underlying disease (mesenteric thrombosis, surgical complications and injury, complications of therapy for cancer, Crohn's disease), metabolic abnormalities resulting from morphological and functional changes in the gastrointestinal tract, and to treatment used. We analyzed all these parameters in a large cohort of patients receiving home parenteral nutrition (HPN), to define the incidence of kidney stones and groups of patients particularly at risk of stone formation. One of the objectives of the study was to develop a predictive model of urolithiasis.
This observational retrospective study included 459 SBS patients maintained on home PN in a single center. Patient records were evaluated for demographics, SBS etiology and underlying disease, anatomy of the gastrointestinal tract, intestinal failure classification, nutrition regimen and presence of urolithiasis.
Kidney stones were diagnosed in 24% of patients. No statistically significant differences in incidence were noted between the various etiologic groups. The incidence in patients with a colon in continuity and those with an end stoma was similar. The length of residual small bowel did not play a role in stone formation. There were no statistically significant differences between patients according to the severity of intestinal failure. In patients treated with PN and limited oral feeding, the risk of urolithiasis was twice as high as in patients receiving PN only.
Patients developed urolithiasis with no relation to the SBS etiology. The risk of kidney stone formation was higher in patients on PN with oral feeding. This article is protected by copyright. All rights reserved.
JPEN. Journal of parenteral and enteral nutrition. 2021 May 02 [Epub ahead of print]
Marcin Rudziński, Michał Ławiński, Łukasz Gradowski, Artur A Antoniewicz, Maciej Słodkowski, Sylwia Bedyńska, Justyna Kostro, Pierre Singer
Department of Urology, Multidisciplinary Hospital Międzylesie, Warsaw, Województwo Mazowiecki, Poland., Department of General Surgery, Gastroenterology and Oncology, Medical University of Warsaw, Warsaw, Poland., SWPS University of Social Sciences and Humanities, Warsaw, Poland., Department of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland., Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Tel Aviv University, Israel.