A 45-Year-Old Man Is Evaluated for Recurrent Urolithiasis

A 45-year-old man is evaluated for recurrent urolithiasis.  He underwent a Roux-en-Y procedure for morbid obesity two years ago.  He passed his first kidney stone one year ago and has passed several since then.  He has lost approximately 15 kg (33 lb) since the surgery and feels well otherwise.  His current medications include lisinopril for hypertension, esomeprazole for gastro-esophageal reflux disease, and a daily multivitamin.  He has no family history of kidney stones.
Which of the following factors is most likely responsible for this patient's kidney stone formation?

A) High urinary oxalate and low urinary citrate
B) Hypercalciuria
C) Hyperuricosuria and low urine pH
D) Low urinary volume
E) Vitamin D deficiency

Correct Answer:

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