Gastric Bypass as Treatment for Obesity: Trends, Characteristics, and Complications

Shinogle, Judith A.; Owings, Maria; Kozak, Lola Jean

doi:10.1038/oby.2005.273

Cited by 37 publications

(26 citation statements)

References 27 publications

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“…Bariatric surgery not only leads to significant long-term weight reduction but also results in decreased mortality and improvement or even resolution of several comorbidities such as diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea (19,20). Consequently, the number of bariatric surgeries performed in the United States has increased dramatically (21).…”

Section: Discussionmentioning

confidence: 99%

Oxalate Nephropathy Complicating Roux-en-Y Gastric Bypass

Nasr

D’Agati

Said

et al. 2008

Clinical Journal of the American Society of Nephrology

182

143

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Background and objectives: The most common bariatric surgery is Roux-en-Y gastric bypass (RYGB), which has been associated with hyperoxaluria and nephrolithiasis. We report a novel association of RYGB with renal insufficiency as a result of oxalate nephropathy.Design, setting, participants, & measurements: Eleven cases of oxalate nephropathy after RYGB were identified from the Renal Pathology Laboratory of Columbia University. The clinical features, pathologic findings, and outcomes are described.Results: Patients were predominantly white (72.7%) with a mean age of 61.3 yr. Indications for RYGB included morbid obesity (eight patients) and reconstruction after total gastrectomy for gastric cancer (three patients). All 11 patients had a history of hypertension, and 9 were diabetic. Patients presented with acute renal failure, often superimposed on mild chronic renal insufficiency (n ‫؍‬ 7), at a median of 12 mo after RYGB. The mean creatinine at baseline, at discovery of acute renal failure, and at biopsy was 1.5, 5.0, and 6.5 mg/dl, respectively. Renal biopsies revealed diffuse tubular degenerative changes, abundant tubular calcium oxalate deposits, and varying degrees of tubulointerstitial scarring. In addition, seven biopsies had underlying diabetic glomerulosclerosis and two had glomerulosclerosis attributable to obesity and hypertension. Eight of 11 patients rapidly progressed to ESRD and required hemodialysis at a mean of 3.2 wk after renal biopsy. The remaining three patients were left with significant chronic kidney disease.Conclusions: Oxalate nephropathy is an underrecognized complication of RYGB and typically results in rapid progression to ESRD. Patients with pre-existing renal disease may be at higher risk for this complication.

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Section: Discussionmentioning

confidence: 99%

Oxalate Nephropathy Complicating Roux-en-Y Gastric Bypass

Nasr

D’Agati

Said

et al. 2008

Clinical Journal of the American Society of Nephrology

182

143

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show abstract

“…9 Men have a slightly lower rate of morbid obesity when compared with women (2.8% of men and 6.9% of women had morbid obesity in a recent assessment 7 ) but 40% of individuals with morbid obesity are men 10 while only about 15% of those having surgery are men.…”

mentioning

confidence: 95%

Toward the Rational and Equitable Use of Bariatric Surgery

Flum

Khan

Dellinger

2007

JAMA

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“…RYGB now accounts for approximately 85% of the weight loss operations performed in the USA. 8 More recent studies comparing the RYGB to a newer restrictive operation, the laparoscopic adjustable gastric band (LAGB), suggest that the RYGB results in an increase in the plasma concentration of the well-known satiety hormone peptide YY as well as GLP-1 compared to the LAGB, possibly accounting for its greater effect on weight loss and resolution of diabetes compared to mechanical restriction of the proximal stomach alone. 9 Although this latter observation is highly contested among LAGB proponents, rigorously performed prospective trials are not yet available.…”

Section: Roux-en-y Gastric Bypassmentioning

confidence: 99%