Recovery of Renal Function in a Dialysis-Dependent Patient Following Gastric Bypass Surgery

Abstract

There is increasing evidence that obesity, independently from other comorbidities such as diabetes and hypertension, can cause renal dysfunction. While this indolent dysfunction may be asymptomatic, it can render patients more susceptible to renal insufficiency when the kidneys are further injured by other pathological processes. Here, we present a morbidly obese patient whose type-A aortic dissection was complicated by acute renal failure that subsequently progressed into end-stage renal disease. However, his renal function improved dramatically following substantial weight reduction after gastric bypass surgery obviating the need for dialysis and transplantation. The potential mechanisms by which a patient's obesity may lead to renal dysfunction are discussed. This case and other similar reports suggest that obese patients with renal failure can safely undergo bariatric surgery and that bariatric surgery may have a role in treating chronic kidney disease in select morbidly obese patients.

Determinants of resource utilization and outcomes in laparoscopic Roux-en-Y gastric bypass: a multicenter analysis of 14,251 patients

“…A few case series on bariatric surgery in patients with dialysis dependence have suggested that bariatric surgery results in improvement of renal function postoperatively [37][38][39]. The explanation provided is that obesity is a major risk factor for chronic kidney disease, and reduction in weight with bariatric surgery may result in improvement in glomerular hyperfiltration, and reduction in proteinuria, thereby improving overall renal function [37]. Although the long-term effect of bariatric surgery on renal function remains beyond the scope of NSQIP, the 8.5 times higher risk of postoperative complications must be kept in mind while offering surgery to these patients.…”

Obesity in CKD—What Should Nephrologists Know?

“…83 Notably, there is a case report of recovery of kidney function in a dialysis-dependent patient after bariatric surgery. 84 In a study of 34 morbidly obese patients, surgically induced weight loss contributed to a decrease in markers of renal inflammation and BP. 85 Moreover, in a study of 255 morbidly obese type 2 diabetic patients, changes in BMI 12 months after bariatric surgery were the only independent predictors of albumin-to-creatinine ratio normalization.…”

Bariatric Surgery and Renal Function

“…He did, however, receive dialysis for a brief period after the operation. Tafti et al [29] report the impact of robotic gastric bypass on a patient with chronic kidney impairment following type A aortic dissection which caused ischaemic renal damage. His renal function deteriorated and he needed to undergo dialysis.…”