Improvement and stabilization of chronic kidney disease after gastric bypass

• Published in: Surgery for obesity and related diseases Vol. 5; no. 2; pp. 237 - 241
• Main Authors: Alexander, J. Wesley, M.D., Sc.D, Goodman, Hope R., M.P.T, Martin Hawver, Lisa R., M.D, Cardi, Michael A., M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2009
• Subjects: Adult; Biopsy; Body Mass Index; Chronic Disease; Chronic kidney disease; Diabetic Nephropathies - complications; Diabetic Nephropathies - diagnosis; Diabetic Nephropathies - physiopathology; Female; Focal segmental glomerulonephritis; Follow-Up Studies; Gastric bypass; Gastric Bypass - methods; Gastroenterology and Hepatology; Glomerular Filtration Rate - physiology; Glomerulonephritis, Membranous - diagnosis; Glomerulonephritis, Membranous - etiology; Glomerulonephritis, Membranous - physiopathology; Glomerulosclerosis, Focal Segmental - diagnosis; Glomerulosclerosis, Focal Segmental - etiology; Glomerulosclerosis, Focal Segmental - physiopathology; Humans; Male; Middle Aged; Obesity, Morbid - complications; Obesity, Morbid - surgery; Obesity-related proteinuria; Recovery of Function; Surgery; Time Factors; Treatment Outcome; Weight Loss; Young Adult; Obesity-related proteinuria; Chronic kidney disease; Focal segmental glomerulonephritis; Gastric bypass
• ISSN: 1550-7289; 1878-7533
• DOI: 10.1016/j.soard.2008.08.016

Abstract Background To more clearly establish the extent to which surgical weight loss can alter the course of established renal disease at a bariatric surgical service at a university-affiliated hospital. Methods Of a series of 45 nontransplant patients with established renal disease who had undergone gastric bypass, 9 had resolution, improvement, or stabilization of their kidney function. Two of these patients were already receiving, or were ready for, dialysis. Their average age at gastric bypass was 43.0 ± 4.3 years, and their mean body mass index was 48.9 ± 1.9 kg/m2 . Of these 9 patients, 5 had a primary diagnosis of focal segmental glomerulosclerosis, 2 had membranous glomerulonephritis, and 2 had diabetic nephropathy. Results No leaks, splenic injury, transfusions, infections starting in the deep parts of the wound, death, or serious complications occurred. One patient had biopsy-proven membranous glomerulonephritis that completely resolved and has had 9 years of postoperative follow-up. The 2 dialysis patients were able to discontinue dialysis for 27 and 7 months, respectively. The remaining patients had stable renal function for 2–5 years postoperatively. Conclusion In some patients with chronic kidney disease, gastric bypass results in stabilization or improvement of their kidney disease. Excess body weight loss seems to have the most positive effect in patients with obesity-related focal segmental glomerulosclerosis.