Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA.
Surgery. 2010 Feb;147(2):282-7. doi: 10.1016/j.surg.2009.09.017. Epub 2009 Dec 11.
Obesity and type 2 diabetes are associated with renal dysfunction, which improves after Roux-en-Y gastric bypass (RYGB). During a 12-month follow-up period, we studied prospectively the changes in glomerular and tubular functions that occurred in excessively obese diabetic and non diabetic subjects after RYGB.
The cohort included 35 patients, 54% of whom had type 2 diabetes. Glomerular filtration rate (GFR) was estimated using creatinine clearance. Tubular function was studied by measuring the ratio of urinary cystatin C to urinary creatinine (UCC ratio).
Baseline renal parameters, anthropometric characteristics, and changes in body mass index after the surgical procedures were similar between the 2 cohorts. At 12 months after RYGB, creatinine clearance decreased 15% in diabetics (P = .02) and 21% in nondiabetics (P = .03). A change in GFR was seen earlier in the nondiabetics (-29% after 6 months; P = .003). The UCC ratio was increased at both 6- and 12-month follow-ups (P = .03 and .003, respectively) only in the diabetic group.
GFR was improved at 12 months after RYGB, with nondiabetics showing a greater propensity score. Tubular function remained unchanged in the nondiabetic subjects, but worsening occurred in the diabetic subjects. These results underscore the importance of reversal of excessive obesity before the onset of frank diabetes.
肥胖症和 2 型糖尿病与肾功能障碍有关，而这种障碍在 Roux-en-Y 胃旁路手术（RYGB）后会得到改善。在为期 12 个月的随访期间，我们前瞻性地研究了 RYGB 后过度肥胖的糖尿病和非糖尿病患者肾小球和肾小管功能的变化。
该队列包括 35 名患者，其中 54%患有 2 型糖尿病。肾小球滤过率（GFR）通过肌酐清除率来估计。通过测量尿胱抑素 C 与尿肌酐的比值（UCC 比值）来研究肾小管功能。
两组患者的基线肾脏参数、人体测量特征以及手术后体重指数的变化均相似。在 RYGB 后 12 个月，糖尿病患者的肌酐清除率下降了 15%（P=0.02），而非糖尿病患者下降了 21%（P=0.03）。在非糖尿病患者中，GFR 的变化更早出现（6 个月后下降了 29%；P=0.003）。仅在糖尿病组中，UCC 比值在 6 个月和 12 个月随访时均升高（分别为 P=0.03 和 P=0.003）。
RYGB 后 12 个月时 GFR 得到改善，非糖尿病患者的改善程度更大。在非糖尿病患者中，肾小管功能保持不变，但在糖尿病患者中出现恶化。这些结果强调了在 2 型糖尿病出现之前逆转过度肥胖的重要性。
