Early Improvement in Albuminuria in Non-diabetic Patients after Roux-en-Y Bariatric Surgery

Mohan, Sumit; Tan, Jian; Gorantla, Saritha; Ahmed, Leaque; Park, Constance M.

doi:10.1007/s11695-011-0437-7

Cited by 17 publications

(7 citation statements)

References 50 publications

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“…Others have shown that even moderate weight reduction in patients with type 2 diabetes with proteinuria, reduces urine protein excretion by approximately 30% 80 . Furthermore, weight reduction achieved through either dietary caloric restriction or bariatric surgery has been shown to attenuate progression of proteinuria in obese non-diabetic individuals 81–82 .…”

Section: Pathophysiology Of Obesity and Diabetes-related Kidney Diseasementioning

confidence: 99%

Obesity and Diabetic Kidney Disease

Maric‐Bilkan

2013

Medical Clinics of North America

146

119

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Section: Pathophysiology Of Obesity and Diabetes-related Kidney Diseasementioning

confidence: 99%

Obesity and Diabetic Kidney Disease

Maric‐Bilkan

2013

Medical Clinics of North America

146

119

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“…Indeed, different indexes of overweight (BMI, waist to hip ratio and waist circumference) have been associated with increased albuminuria in both non-diabetic and diabetic populations [ 14 – 17 ]. Weight reduction has also been demonstrated to reduce albuminuria in non-diabetic obese individuals [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Longitudinal Association between Serum Leptin Concentration and Glomerular Filtration Rate in Humans

et al. 2015

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BackgroundObesity is a risk factor for decline in glomerular filtration rate (GFR). One proposed mechanism leading to glomerulopathy is an increase in leptin levels. However, the association between leptin and GFR has never been demonstrated. The aim of this study is to verify whether higher levels of leptin are associated with longitudinal changes of estimated GFR (eGFR).Methods and findingsWe selected 744 participants in the InCHIANTI study (416 women). The association between eGFR and leptin changes over a 6-years follow-up was assessed using random effect models including leptin as a time-varying covariate and adjusted for potential confounders. We also compared the proportion of patients with rapid decline of renal function across tertiles of change in serum leptin between baseline and 6-years follow-up. Mean baseline eGFR was 82.2 ml/min/1.73 m, 78.7 ml/min/1.73 m, and 75.4 ml/min/1.73 m in the first, second and third tertile of baseline serum leptin concentration, respectively. After adjustment for potential confounders, leptin concentration was inversely associated with changes of eGFR over time (β for log-leptin: -1.288, 95% CI: -2.079 – -0.497). Relative to baseline levels, the estimated change in eGFR for unit-increase in log-leptin was -1.9% (95% CI: -2.977 – -0.761). After stratification by sex, the results were confirmed in women only. In women we also found an association between increasing leptin concentration over time and rapid decline of renal function.ConclusionsIn women, serum leptin may contribute to eGFR decline independently from obesity and diabetes mellitus, although a cause-effect relationship cannot be established due to the observational nature of our study. A better characterization of adipokine profile of obese individuals may shed light on the accelerated renal function decline reported in a proportion of high-risk obese individuals.

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“…Due to their outcomes could not be combined with other studies, 2 studies [ 41 , 48 ] were excluded from meta-analysis. 14 studies of 1186 patients with dichotomous data [ 21 , 23 , 24 , 26 , 27 , 29 , 32 – 34 , 38 , 42 , 43 , 45 , 51 ] and 10 studies of 930 patients with continuous data [ 24 , 25 , 29 , 33 , 36 , 37 , 46 , 47 , 49 , 50 ] were included in the meta-analysis of albuminuria and proteinuria. There were only 5 studies of 184 patients [ 25 , 26 , 28 , 40 , 44 ] in the review of CKD II.…”

Section: Resultsmentioning

confidence: 99%

Effects of Bariatric Surgery on Renal Function in Obese Patients: A Systematic Review and Meta Analysis

Zou

et al. 2016

PLoS ONE

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BackgroundObesity is an independent risk factor of development and progression of chronic kidney disease (CKD). Data on the benefits of bariatric surgery in obese patients with impaired kidney function have been conflicting.ObjectiveTo explore whether there is improvement in glomerular filtration rate (GFR), proteinuria or albuminuria after bariatric surgery.MethodsWe comprehensively searched the databases of MEDLINE, Embase, web of science and Cochrane for randomized, controlled trials and observational studies that examined bariatric surgery in obese subjects with impaired kidney function. Outcomes included the pre- and post-bariatric surgery GFR, proteinuria and albuminuria. In obese patients with hyperfiltration, we draw conclusions from studies using measured GFR (inulin or iothalamate clearance) unadjusted for BSA only. Study quality was evaluated using the Newcastle-Ottawa Scale.Results32 observational studies met our inclusion criteria, and 30 studies were included in the meta-analysis. No matter in dichotomous data or in dichotomous data, there were statistically significant reduction in hyperfiltration, albuminuria and proteinuria after bariatric surgery.LimitationsThe main limitation of this meta-analysis is the lack of randomized controlled trials (RCTs). Another limitation is the lack of long-term follow-up.ConclusionsBariatric surgery could prevent further decline in renal function by reducing proteinuria, albuminuria and improving glomerular hyperfiltration in obese patients with impaired renal function. However, whether bariatric surgery reverses CKD or delays ESRD progression is still in question, large, randomized prospective studies with a longer follow-up are needed.

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Early Improvement in Albuminuria in Non-diabetic Patients after Roux-en-Y Bariatric Surgery

Abstract: Improvements in microalbuminuria in the early post-operative period after Roux-en-Y surgery may result from an interplay between changes in gastrointestinal hormones, insulin sensitivity, blood pressure, and adipose tissue-and needs further study.

Cited by 17 publications

References 50 publications

Obesity and Diabetic Kidney Disease

Obesity and Diabetic Kidney Disease

Longitudinal Association between Serum Leptin Concentration and Glomerular Filtration Rate in Humans

Effects of Bariatric Surgery on Renal Function in Obese Patients: A Systematic Review and Meta Analysis

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