Improvement and stabilization of chronic kidney disease after gastric bypass
Improvement and stabilization of chronic kidney disease after gastric bypass
复制标题
DOI：
10.1016/j.soard.2008.08.016
复制
发表时间：
2009-03-01
影响因子：
3.1
通讯作者：
Cardi, Michael A.
中科院分区：
文献类型：
--
作者：
Alexander, J. Wesley;Goodman, Hope R.;Cardi, Michael A.
背景：在一所大学附属医院的减肥外科服务中，为了更清楚地确定手术减肥在多大程度上可以改变既定肾脏疾病的病程。方法：在45例经胃分流术的非移植肾脏疾病患者中，9例患者的肾功能得到缓解、改善或稳定。其中两名患者已经接受或准备接受透析。他们在胃旁路手术时的平均年龄为43.0±4.3岁，平均体重指数为48.9±1.9 kg/m(2)。9例患者中，5例初步诊断为局灶节段性肾小球硬化，2例为膜性肾小球肾炎，2例为糖尿病肾病。结果：无泄露、脾损伤、输血、创面深部感染、死亡及严重并发症发生。1例患者活检证实膜性肾小球肾炎完全消退，术后随访9年。2例患者分别能够停止透析27个月和7个月。其余患者术后2-5年肾功能稳定。结论：在一些慢性肾脏疾病患者中，胃旁路治疗可以稳定或改善其肾脏疾病。超重体重减轻似乎对肥胖相关局灶节段性肾小球硬化患者有最积极的影响。（中华外科杂志2009；5:237-241）(C) 2009年美国代谢与减肥外科学会。版权所有。
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 2 bypass was 43.0 +/- 4.3 years, and their mean body mass index was 48.9 +/- 1.9 kg/m(2). Of these 9 patients, 5 had a primary diagnosis of focal segmental glomerulosclerosis, 2 had membranous glomerulonephritis, an([ 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. (Surg Obes Relat Dis 2009;5: 237-241.) (C) 2009 American Society for Metabolic and Bariatric Surgery. All rights reserved.