Bone and metabolic complications of urinary diversions

Endocrinol Nutr. 2015 Feb;62(2):100-5. doi: 10.1016/j.endonu.2014.10.007. Epub 2014 Dec 4.
[Article in English, Spanish]

Abstract

Hyperchloremic metabolic acidosis is a complication of urinary diversion using ileum or colon. Its prevalence ranges from 25% and 46% depending on the procedure used and renal function of the patient. It is a consequence of intestinal fluid and electrolyte exchange between intestinal mucosa and urine. The main mechanism is absorption of ammonium and chloride from urine. Long-term chronic metabolic acidosis in these patients may lead to impaired bone metabolism and osteomalacia. Regular monitoring of pH, chlorine, bicarbonate, and calcium-phosphorus metabolism is therefore essential for early diagnosis and treatment.

Keywords: Acidosis metabólica; Conducto ileal; Derivación urinaria; Hipopotasemia; Hypokalemia; Ileal conduit; Metabolic acidosis; Neobladder; Neovejiga; Urinary diversion.

Publication types

  • Review

MeSH terms

  • Acidosis / etiology*
  • Alkalosis / etiology
  • Bicarbonates / blood
  • Bone Diseases, Metabolic / etiology*
  • Calcium / blood
  • Chlorides / blood
  • Colon / surgery
  • Gastric Mucosa / metabolism
  • Humans
  • Hypokalemia / etiology
  • Intestinal Absorption
  • Intestinal Mucosa / metabolism
  • Intestine, Small / surgery
  • Osteomalacia / etiology
  • Phosphorus / blood
  • Postoperative Complications / etiology*
  • Stomach / surgery
  • Urinary Diversion / adverse effects*

Substances

  • Bicarbonates
  • Chlorides
  • Phosphorus
  • Calcium