Weight Loss, Adipokines, and Quality of Life After Sleeve Gastrectomy in Obese Patients With Stages 3-4 CKD: A Randomized Controlled Pilot Study

Abstract

A 61-year-old woman was admitted to our hospital with general fatigue. Laboratory tests showed kidney failure, and imaging showed visceral inversion with polycystic liver and kidneys (Fig 1). Autosomal dominant polycystic kidney disease (ADPKD) with complete situs inversus was diagnosed. Polycystins 1 and 2, proteins encoded by the PKD1 and PKD2 genes, respectively, are known to localize to renal tubular primary cilia. In addition, experiments in mice have shown that polycystin 2 has a role in left-right determination during embryogenesis. 1 In humans, the association of PKD2 mutations with left-right laterality defects was reported first in 2011. 2 In our patient, we identified a novel heterozygous mutation at nucleotide 973 in the coding sequence of PKD2. The mutation, a substitution of cytosine by thymine, changes the arginine codon at amino acid 325 to a TGA stop codon, suggesting that mutant form of polycystin 2 is prematurely truncated. It is likely that our patient's PKD2 mutation caused both ADPKD and complete situs inversus with a possible involvement of cilia dysfunction.

Bariatric surgery is associated with improvement in kidney outcomes

“…8,12,14 One study of 13 patients with CKD who underwent bariatric surgery found that indexed mGFR and eGFR increased, leptin and adiponectin levels normalized, and C-reactive protein decreased 12 months after surgery. 12 Inflammation and dysregulated adipocytokines have both been postulated to have adverse effects on kidney.…”

Bariatric Surgery and Kidney-Related Outcomes

“…In a study led by Navaneethan et al. , 13 patients with serum creatinine ≥ 1.3 mg/dl underwent measurement of GFR using iothalamate clearance before surgery and 3, 6, and 12 months after bariatric surgery (RYGB, 7; LAGB, 3; LSG, 3) 47 . In contrast to the studies in patients with preserved GFR, unindexed mGFR in this CKD cohort remained unchanged at 12 months (82.0−80.5 ml/min, P  = 0.3).…”

Can Bariatric Surgery Be a Surgical Treatment to Prevent the Progression of Chronic Kidney Disease?

“…Baseline kidney disease included glomerular hyperfiltration [13][14][15]19], overt CKD [16][17][18][19][20][21][22][23][24], or end-stage renal disease [16]. There are two studies [16,20] including patients on hemodialysis (HD) treatment.…”

“…The type of surgery performed in these studies is heterogeneous. 4 studies considered Roux-en-Y gastric bypass [15][16][17]23], and 2 studies [20,24] performed sleeve gastrectomy, in which MacLaughlin et al [20] used laparoscopic sleeve gastrectomy, to achieve weight loss. In the study by Hou et al [19], of 233 total patients, 184 patients underwent gastric bypass, 32 patients had sleeve gastrectomy and gastric banding was performed for 14 remaining patients.…”