Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 3/2012

01-03-2012 | Clinical Research

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

Authors: Sumit Mohan, Jennifer Tan, Saritha Gorantla, Leaque Ahmed, Constance M. Park

Published in: Obesity Surgery | Issue 3/2012

Login to get access

Abstract

Background

Obesity is a growing epidemic in the USA that has been shown to be associated with chronic kidney disease and albuminuria. Bariatric surgery is an effective means of achieving long-term weight loss and improvements in metabolic derangements including albumin excretion over the long term.

Methods

We report changes in urinary albumin excretion levels in the early post-operative period for a euglycemic, predominantly Hispanic American cohort undergoing Roux-en-Y gastric bypass surgery.

Results

Our cohort of 38 patients was largely female (89.5%) and predominantly Hispanic (76.3%) with a mean BMI of 46 ± 8.0 kg/m2. Over half (53.3%) of the patients with significant preoperative albumin excretion in our cohort lowered their albumin excretion levels to <20 mg/g of creatinine. This early reduction in albumin excretion in our cohort correlated significantly with the level of albumin excretion preoperatively but not with the degree of weight loss experienced in this early post-operative period.

Conclusions

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.
Literature
1.
Hsu C-y, McCulloch CE, Iribarren C, et al. Body mass index and risk for end-stage renal disease. Ann Intern Med. 2006;144:21–8.PubMed
2.
Ejerblad E, Fored CM, Lindblad P, et al. Obesity and risk for chronic renal failure. J Am Soc Nephrol. 2006;17:1695–702.PubMedCrossRef
3.
Strengel B, Tarver-Carr M, Powe N, et al. Lifestyle factors, obesity and the risk of chronic kidney disease. Epidemiology. 2003;14:479–87.
4.
Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295:1549–55.PubMedCrossRef
5.
Wahba IM, Mak RH. Obesity and obesity-initiated metabolic syndrome: mechanistic links to chronic kidney disease. Clin J Am Soc Nephrol. 2007;2:550–62.PubMedCrossRef
6.
Klausen KP, Parving HH, Scharling H, et al. Microalbuminuria and obesity: impact on cardiovascular disease and mortality. Clin Endocrinol. 2009;71:40–5.CrossRef
7.
Griffin KA, Kramer H, Bidani AK. Adverse renal consequences of obesity. Am J Physiol Ren Physiol. 2008;294:F685–96.CrossRef
8.
Bonnet F, Deprele C, Sassolas A, et al. Excessive body weight as a new independent risk factor for clinical and pathological progression in primary IgA nephritis. Am J Kidney Dis. 2001;37:720–7.PubMedCrossRef
9.
Kambham N, Markowitz GS, Valeri AM, et al. Obesity-related glomerulopathy: an emerging epidemic. Kidney Int. 2001;59:1498–509.PubMedCrossRef
10.
Serra A, Romero R, Lopez D, et al. Renal injury in the extremely obese patients with normal renal function. Kidney Int. 2008;73:947–55.PubMedCrossRef
11.
Brantsma AH, Bakker SJL, de Zeeuw D, et al. Urinary albumin excretion as a predictor of the development of hypertension in the general population. J Am Soc Nephrol. 2006;17:331–5.PubMed
12.
Ferris M, Hogan SL, Chin H, et al. Obesity, albuminuria, and urinalysis findings in US young adults from the add health wave III study. Clin J Am Soc Nephrol. 2007;2:1207–14.PubMedCrossRef
13.
Hillege HL, Fidler V, Diercks GFH, et al. Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population. Circulation. 2002;106:1777–82.PubMedCrossRef
14.
Hillege HL, Janssen WMT, Bak A, et al. Microalbuminuria is common, also in a nondiabetic, nonhypertensive population, and an indicator of cardiovascular risk factors and cardiovascular morbidity. J Intern Med. 2001;249:519–26.PubMedCrossRef
15.
Tapp RJ, Shaw JE, Zimmet PZ, et al. Albuminuria is evident in the early stages of diabetes onset: results from the Australian diabetes, obesity, and lifestyle study (AusDiab). Am J Kidney Dis. 2004;44:792–8.PubMed
16.
Murtaugh MA, Jacobs Jr DR, Yu X, et al. Correlates of urinary albumin excretion in young adult blacks and whites: the coronary artery risk development in young adults study. Am J Epidemiol. 2003;158:676–86.PubMedCrossRef
17.
Sharma K. The link between obesity and albuminuria: adiponectin and podocyte dysfunction. Kidney Int. 2009;76:145–8.PubMedCrossRef
18.
de Zeeuw D, Parving H-H, Henning RH. Microalbuminuria as an early marker for cardiovascular disease. J Am Soc Nephrol. 2006;17:2100–5.PubMedCrossRef
19.
Klausen KP, Parving HH, Scharling H, et al. Microalbuminuria and obesity: impact on cardiovascular disease and mortality. Clin Endocrinol. 2009;71:40–5.CrossRef
20.
Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among us adults, 1999–2000. JAMA. 2002;288:1723–7.PubMedCrossRef
21.
Verhave JC, Hillege HL, Burgerhof JGM, et al. Cardiovascular risk factors are differently associated with urinary albumin excretion in men and women. J Am Soc Nephrol. 2003;14:1330–5.PubMedCrossRef
22.
Bello AK, de Zeeuw D, Nahas ME, et al. Impact of weight change on albuminuria in the general population. Nephrol Dial Transplant. 2007;22:1619–27.PubMedCrossRef
23.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRef
24.
Stevens VJ, Obarzanek E, Cook NR, et al. Long-term weight loss and changes in blood pressure: results of the trials of hypertension prevention, phase II. Ann Intern Med. 2001;134:1–11.PubMed
25.
Klein S, Sheard NF, Pi-Sunyer X, et al. Weight management through lifestyle modification for the prevention and management of type 2 diabetes: rationale and strategies: a statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition. Diabetes Care. 2004;27:2067–73.PubMedCrossRef
26.
Neter JE, Stam BE, Kok FJ, et al. Influence of weight reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension. 2003;42:878–84.PubMedCrossRef
27.
Solerte S, Fioravanti M, Schifino N, et al. Effects of diet-therapy on urinary protein excretion albuminuria and renal hemodynamic function in obese diabetic patients with overt nephropathy. Int J Obes. 1989;13:203–11.PubMed
28.
Navarro-Diaz M, Serra A, Romero R, et al. Effect of drastic weight loss after bariatric surgery on renal parameters in extremely obese patients: long-term follow-up. J Am Soc Nephrol. 2006;17:S213–7.PubMedCrossRef
29.
Chagnac A, Weinstein T, Herman M, et al. The effects of weight loss on renal function in patients with severe obesity. J Am Soc Nephrol. 2003;14:1480–6.PubMedCrossRef
30.
Agrawal V, Khan I, Rai B, et al. The effect of weight loss after bariatric surgery on albuminuria. Clin Nephrol. 2008;70:194–202.PubMed
31.
Saiki A, Nagayama D, Ohhira M, et al. Effect of weight loss using formula diet on renal function in obese patients with diabetic nephropathy. Int J Obes Relat Metab Disord. 2005;29:1115–20.CrossRef
32.
Agrawal V, Krause KR, Chengelis DL, et al. Relation between degree of weight loss after bariatric surgery and reduction in albuminuria and C-reactive protein. Surg Obes Relat Dis. 2009;5:20–6.PubMedCrossRef
33.
Rubino FMD, Gagner MMDF, Gentileschi PMD, et al. The early effect of the Roux-en-Y gastric bypass on hormones involved in body weight regulation and glucose metabolism. Ann Surg. 2004;240:236–42.PubMedCrossRef
34.
Praga M. Obesity–a neglected culprit in renal disease. Nephrol Dial Transplant. 2002;17:1157–9.PubMedCrossRef
35.
de Jong P, Verhave J, Pinto-Sietsma S, et al. Obesity and target organ damage: the kidney. Int J Obes Relat Metab Disord. 2002;26:S21–4.PubMedCrossRef
36.
Bosma R, van der Heide J, Oosterop E, et al. Body mass index is associated with altered renal hemodynamics in non-obese healthy subjects. Kidney Int. 2004;65:259–65.PubMedCrossRef
37.
Bomback AS, Klemmer P. Interaction of aldosterone and extracellularvolume in the pathogenesis of obesity associated kidney disease: a narrative review. Am J Nephrol. 2009;30:140–6.PubMedCrossRef
38.
Krikken J, Lely A, Bakker A, et al. The effect of teh a shift in sodium intake on renal hemodynamics is determined by body mass index in health young men. Kidney Int. 2007;71:260–5.PubMedCrossRef
39.
Bigazzi R, Bianchi S, Bladari D, et al. Microalbuminuria in salt sensitive patients. A marker for renal and cardiovascular risk factors. Hypertension. 1994;23:195–9.PubMed
40.
Wolf G, Hamann A, Han D, et al. Leptin stimulates proliferation and TGF-β expression in renal glomerular endothelial cells: potential role in glomerulosclerosis. Kidney Int. 1999;56:860–72.PubMedCrossRef
41.
Sharma K, Ramachandrarao S, Qiu G, et al. Adiponectin regulates albuminuria and podocyte function in mice. J Clin Invest. 2008;118:1645–56.PubMed
42.
Serra A, Granada ML, Romero R, et al. The effect of bariatric surgery on adipocytokines, renal parameters and other cardiovascular risk factors in severe and very severe obesity: 1-year follow-up. Clin Nutr. 2006;25:400–8.PubMedCrossRef
43.
Campos GM, Rabl C, Peeva S, et al. Improvement in peripheral glucose uptake after gastric bypass surgery is observed only after substantial weight loss has occurred and correlates with the magnitude of weight lost. J Gastrointest Surg. 2010;14:15–23.PubMedCrossRef
44.
De Simone G, Mancini M, Mainenti G, et al. Weight reduction lowers blood pressure independently of salt restriction. J Endocrinol Investig. 1992;15:339–43.
45.
Cutler JA. Randomized clinical trials of weight reduction in nonhypertensive persons. Ann Epidemiol. 1991;1:363–70.PubMedCrossRef
46.
Laferrere B, Heshka S, Wang K, et al. Incretin levels and effect are markedly enhanced 1 month after Roux-en-Y gastric bypass surgery in obese patients with type 2 diabetes. Diabetes Care. 2007;30:1709–16.PubMedCrossRef
47.
Muscelli E, Mingrone G, Camastra S, et al. Differential effect of weight loss on insulin resistance in surgically treated obese patients. Am J Med. 2005;118:51–7.PubMedCrossRef
48.
Pournaras DJ, Osborne A, Hawkins SC, et al. Remission of type 2 diabetes after gastric bypass and banding: mechanisms and 2 year outcomes. Ann Surg. 2010;252:966–71.PubMedCrossRef
49.
Bose M, Oliván B, Teixeira J, et al. Do incretins play a role in the remission of type 2 diabetes after gastric bypass surgery: what are the evidence? Obes Surg. 2009;19:217–29.PubMedCrossRef
50.
Abu-Hamdah R, Rabiee A, Meneilly GS, et al. Clinical review: the extrapancreatic effects of glucagon-like peptide-1 and related peptides. J Clin Endocrinol Metab. 2009;94:1843–52.PubMedCrossRef
51.
Yu M, Moreno C, Hoagland KM, et al. Antihypertensive effect of glucagon-like peptide 1 in Dahl salt-sensitive rats. J Hypertens. 2003;21:1125–35.PubMedCrossRef
Metadata
Title
Early Improvement in Albuminuria in Non-diabetic Patients after Roux-en-Y Bariatric Surgery
Authors
Sumit Mohan
Jennifer Tan
Saritha Gorantla
Leaque Ahmed
Constance M. Park
Publication date
01-03-2012
Publisher
Springer-Verlag
Published in
Obesity Surgery / Issue 3/2012
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-011-0437-7

Other articles of this Issue 3/2012

Obesity Surgery 3/2012 Go to the issue

Scholarly Presentation

Initial Learning Experience of Laparoendoscopic Single Site (LESS) Gastric Banding: Finding Predictors of Success

Clinical Research

Is Laparoscopic Duodenojejunal Bypass with Sleeve an Effective Alternative to Roux En Y Gastric Bypass in Morbidly Obese Patients: Preliminary Results of a Randomized Trial

Clinical Research

Prevalence and Co-occurrence of Upper and Lower Functional Gastrointestinal Symptoms in Patients Eligible for Bariatric Surgery

Animal Research

Myocardial Insulin Signaling and Glucose Transport Are Up-regulated in Goto–Kakizaki Type 2 Diabetic Rats After Ileal Transposition

Clinical Research

Impaired Abdominal Skin Sensory Function in Morbid Obesity and After Bariatric Surgery

Current Status

Thirty-Five Years of Biliopancreatic Diversion: Notes on Gastrointestinal Physiology to Complete the Published Information Useful for a Better Understanding and Clinical Use of the Operation