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Bariatric Surgery CKD Evidence — ESENeph MCQ

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HardDiabetic Kidney DiseaseBariatric Surgery CKD EvidenceESENeph

A patient develops progressive CKD, recurrent calcium-oxalate stones and biopsy-proven oxalate nephropathy two years after Roux-en-Y gastric bypass. Which prevention strategy addresses the mechanism?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Low-fat low-oxalate diet, calcium with meals and high fluid intake

Explanation lettering: C = shown as A · E = shown as B · B = shown as C · A = shown as E

B is correct. Fat malabsorption leaves less luminal calcium available to bind oxalate, so soluble oxalate is absorbed and excreted by the kidney. Reducing fat and oxalate, taking calcium with oxalate-containing meals, maintaining high urine volume and addressing diarrhoea or bile-acid malabsorption target that pathway. A removes the intestinal binder. C increases free fatty acids and calcium saponification. D worsens urinary concentration. E supplies an oxalate precursor. Citrate may help selected patients, but therapy is monitored using urine chemistry and nutritional status because overly restrictive diets can cause further deficiency.

Reference: Clinical Kidney Journal review of enteric hyperoxaluria: https://pmc.ncbi.nlm.nih.gov/articles/PMC8011014/