Serpa Neto Ary, Bianco Rossi Felipe Martin, Dal Moro Amarante Rodrigo, Alves Buriti Nara, Cunha Barbosa Saheb Gabriel, Rossi Marçal
Division of Clinical and Surgical Treatment of Obesity, ABC Medicine School, São Paulo, Brazil.
J Nephrol. 2009 Sep-Oct;22(5):637-46.
Morbid obesity (MO) is associated with increased renal plasma flow (RPL) and glomerular filtration rate (GFR). This type of obesity usually does not respond to medical treatment, with bariatric surgery being the current treatment of choice. The present study aimed to evaluate whether weight loss may reverse the glomerular hyperfiltration of MO patients.
This was a retrospective study of 140 patients submitted to Roux-en-Y gastric bypass (31.5% men, mean body mass index 46.17 +/- 5). Renal glomerular function and anthropometric and biochemical parameters were studied in patients before and 8 months after the surgery. GFR was determined by 24-hour urine samples.
In the obese group, GFR before surgery was 148.7 +/- 35.2 ml/min. After the weight loss, GFR decreased to 113.8 +/- 31.7 ml/min (p<0.0001). Homeostasis model assessment-insulin resistance and glycosylated hemoglobin values were higher in MO with hyperfiltration. Weight loss was associated with reduction in blood pressure and GFR. It was found that the variation in systolic and diastolic blood pressure was a predictor of change in GFR.
This study shows that obesity-related glomerular hyperfiltration ameliorates after weight loss. The improvement in hyperfiltration may prevent the development.
病态肥胖（MO）与肾血浆流量（RPL）增加和肾小球滤过率（GFR）升高有关。这类肥胖通常对药物治疗无反应，目前减肥手术是首选治疗方法。本研究旨在评估体重减轻是否可逆转MO患者的肾小球高滤过状态。
这是一项对140例行Roux-en-Y胃旁路手术患者的回顾性研究（男性占31.5%，平均体重指数46.17±5）。对患者手术前及术后8个月的肾小球功能、人体测量学和生化参数进行研究。通过24小时尿样测定GFR。
在肥胖组中，手术前GFR为148.7±35.2 ml/分钟。体重减轻后，GFR降至113.8±31.7 ml/分钟（p<0.0001）。高滤过的MO患者中，稳态模型评估-胰岛素抵抗和糖化血红蛋白值更高。体重减轻与血压和GFR降低相关。发现收缩压和舒张压的变化是GFR变化的预测指标。
本研究表明，体重减轻后与肥胖相关的肾小球高滤过状态得到改善。高滤过状态的改善可能预防疾病发展。
