To the Editor.—
We have read with interest the article by Cryer et al1 titled "Renal Failure After Small Intestinal Bypass for Obesity." We have followed up more than 40 intestinal bypass patients at our institution since 1963 and reported the occurrence of hyperoxaluria and urinary tract calculi in 1973.2In one of our patients, nephrocalcinosis and marked renal insufficiency without clinical or roentgenographic evidence of nephrolithiasis developed ten years after an intestinal bypass operation. A substantial decrease in creatinine clearance and increase in serum creatinine were first noted five years after surgery and moderate deterioration of renal function has continued during the last five years. However, we have not seen renal insufficiency in 21 other patients whether or not they have developed calcium oxalate nephrolithiasis.
Report of a Case.—
A 50-year-old woman weighing 127 kg (280 lb) underwent a 51-cm (20-inch) jejunotransverse colostomy in December 1965. Before