Conference of the Nephropathy Committee of the Argentine Society of Diabetes. Bariatric surgery update in a patient with diabetes and kidney disease. Part 1

• Published in: Revista de la Sociedad Argentina de Diabetes Vol. 55; no. 2; pp. 52 - 69
• Main Authors: Alicia Elbert, Susana Gutt, Estrella Menéndez, María Florencia Aranguren, Bárbara Arinovich, Teresa Bensusan, Guillermo De´Marziani, Guillermo Dieuzeide, Gabriela Medek, Liliana Miriam Obregón, María José Pomares, Jimena Soutelo, Fabiana Vázquez, Gloria Viñes, Mariela Volta, Fabiana Dávila, Yanina Castaño
• Format: Journal Article
• Language: Spanish
• Published: Sello Editorial Lugones 01-06-2021
• Subjects: cirugía bariátrica; cirugía metabólica; diabetes; enfermedad renal crónica; glomerulopatía focal y segmentaria; obesidad
• ISSN: 0325-5247; 2346-9420
• DOI: 10.47196/diab.v55i2.478

The prevalence of obesity and diabetes mellitus are associated with the development of chronic kidney disease and its terminal stages. In individuals affected by obesity, a probably compensatory hyperfiltration mechanism occurs to satisfy the high metabolic demand associated with increased body weight; it is also associated with the presence and development of proteinuria in individuals without kidney disease. Histopathology shows obesity-related focal and segmental glomerulosclerosis in a setting of glomerulomegaly. Metabolic surgery is the most effective means of obtaining substantial and lasting weight loss. The superiority of surgery over medical treatment has been demonstrated only to achieve better glycemic control, as well as a reduction in cardiovascular risk factors. The mechanisms appear to extend beyond the magnitude of weight loss and include improvements in incretin profiles, insulin secretion, and insulin sensitivity. The Nephropathy Committee of the Argentine Diabetes Society carried out this review on mechanisms involved in obesity as a cause of kidney disease or worsening of kidney disease due to diabetes, the mechanisms by which bariatric surgery would benefit patients with diabetes and kidney disease chronic and its terminal stages, the pre and post-surgical controls that should be performed by patients undergoing this type of surgery.