{
  "abstract": "Patients with short bowel syndrome (SBS) are at high risk of developing renal stones. Multiple factors contribute to the risk of nephrolithiasis including repeated dehydration episodes with reduced urine volume, hyperoxaluria and reduced citrate urine excretion. 1 Patients with ostomies are at risk for both uric acid and oxalate stones, while patients with colon in continuity form mainly calcium oxalate renal calculi.1 2 Renal calculi can lead to nephrocalcinosis, renal parenchymal disease, tubulopathy or interstitial disease with long term sequelae including chronic renal failure and end stage renal disease.3 SBS patients are at risk of renal calculi and nephropathy years after parenteral nutrition (PN) cessation.2 The incidence of renal calculi in SBS patients is described at 15-60%.3 4The aim of this study was to determine incidence of renal calculi in paediatric patients with short bowel syndrome (SBS) who have achieved enteral autonomy (EA) and remain under follow-up by the intestinal failure multidisciplinary team in this tertiary centre. In addition, the study aimed to explore potential associations between renal calculi and patient characteristics, including residual bowel anatomy.A retrospective review of the patient records of paediatric SBS patients in EA identified 79 eligible patients (49 males, age 10 months to 19 years); with PN initiated between 2005-2025 and time on PN from 3 months to 2 years. Data were collected on demographics, bowel anatomy, PN duration, time in enteral autonomy and follow up abdominal ultrasound scans (USS). For those children with renal calculi found on USS; urine biochemistry results and therapeutic intervention were reviewed.5/79 (6%) patients reviewed had USS proven renal calculi. 4/5 patients were of extreme prematurity (birth before 28 weeks gestation) and had intestinal resection due to necrotising enterocolitis (NEC). 1/5 had resection due to volvulus at the age of 3 years.All patients had colon in continuity. 2/5 had ileocolonic anastomoses with absent ileo-caecal valves and partial colectomy. 3/5 had jejunoileal anastomosis with intact colons and estimated small bowel lengths of 33, 44 and 49cm at time of resection.2/5 patients had hyperoxaluria, 2/5 had hypocitraturia and 1/5 had no urine biochemistry available: due to stones resolving. 2/5 patients developed renal calculi whilst still receiving PN with the other 3 patients developing calculi at 6, 7 and 13 years post PN cessation.1 patient with hyperoxaluria (volvulus, absent ICV, calculi diagnosed 7 years from PN cessation) required urological stenting; the other 4 patients required medical management alone.The incidence of renal calculi was low in our cohort and nephrolithiasis resolved spontaneously in one patient. Notwithstanding, 1 patient in our cohort required surgical intervention at 7 years post PN. Renal calculi formation is a known and often serious long-term complication of SBS, which may be evident many years following PN cessation; therefore, vigilance is recommended with regular urine oxalate and citrate monitoring and pro-active renal USS to enable early diagnosis and management of renal calculi.3References Thomson CRV. Nephrocalcinosis and nephrolithiasis. In: Nightingale JMD, ed Intestinal failure, San Francisco, CA: Greenwich Medial Media, 2001:227–242.Schaefer JT, Schulz-Heise S, Rueckel A, et al. Frequency and impact of enteric hyperoxaluria in pediatric short bowel syndrome: a retrospective single centre study. Front Pediatr 2023 Jul 12;11:1157696. doi: 10.3389/fped.2023.1157696. PMID: 37502194; PMCID: PMC10369460.Adler M, Millar EC, Deans KA, et al. Dietary management of chronic kidney disease and secondary hyperoxaluria in patients with short bowel syndrome and Type 3 intestinal failure. Nutr 2022 Apr 14;14(8):1646. doi: 10.3390/nu14081646. PMID: 35458207; PMCID: PMC9030588.Grocholski C, Chambrier C, Lauverjat M, et al. Circulating oxalate levels in short bowel syndrome as a severity marker of CKD. Kidney Int Rep 2023 Dec 28;9(3):686–693. doi: 10.1016/j.ekir.2023.12.023. PMID: 38481504; PMCID: PMC10927470.",
  "authors": [
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Elizabeth Morrisroe"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Maureen Lawson"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Andrew Fagbemi"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Rachel Wood"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Timothy Morris"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Virginia Chatzidaki"
    }
  ],
  "title": "OC50 Renal calculi incidence in paediatric short bowel syndrome: a single centre experience",
  "uid": "5ee356fe-2ee2-550a-bcf8-63a3b027d1fc"
}