Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Author Reply
Book Review
Brief Communication
Case Report
Case Series
Clinical Case Report
Clinicopathological Conference
Commentary
Corrigendum
Editorial
Editorial – World Kidney Day 2016
Editorial Commentary
Erratum
Foreward
Guidelines
Image in Nephrology
Images in Nephrology
Letter to Editor
Letter to the Editor
Letters to Editor
Literature Review
Notice of Retraction
Obituary
Original Article
Perspective
Research Letter
Retraction Notice
Review
Review Article
Short Review
Special Article
Special Feature
Special Feature - World Kidney Day
Systematic Review
Technical Note
Varia
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Author Reply
Book Review
Brief Communication
Case Report
Case Series
Clinical Case Report
Clinicopathological Conference
Commentary
Corrigendum
Editorial
Editorial – World Kidney Day 2016
Editorial Commentary
Erratum
Foreward
Guidelines
Image in Nephrology
Images in Nephrology
Letter to Editor
Letter to the Editor
Letters to Editor
Literature Review
Notice of Retraction
Obituary
Original Article
Perspective
Research Letter
Retraction Notice
Review
Review Article
Short Review
Special Article
Special Feature
Special Feature - World Kidney Day
Systematic Review
Technical Note
Varia
View/Download PDF

Translate this page into:

Letters to Editor
24 (
4
); 263-264
doi:
10.4103/0971-4065.133045

Concern, counseling and consent for bariatric surgery

Department of Emergency and Critical Care Medicine, Sri Gokulam Hospitals and Research Institute, Salem, Tamil Nadu, India
Department of Emergency Medicine, Pushpagiri Medical College Hospital, Tiruvalla, Kerala, India
College of Medicine, King Fahd Hospital of the University, University of Dammam, Dammam, Saudi Arabia (KSA)
Department of Internal Medicine, Chennai Medical College Hospital and Research Center, Irungalur, Trichy, Tamil Nadu, India
Address for correspondence: Dr. Subramanian Senthil Kumaran, Department of Emergency and Critical Care Medicine, Sri Gokulam Hospital and Research Institute, Salem - 636 004, Tamil Nadu, India. E-mail: maniansenthil@yahoo.co.in
Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Disclaimer:
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.

Sir,

We read the article by Nagaraju et al. with great interest.[1] The incidence of obesity is increasing at an alarming rate across the globe. Obesity is an independent predictor for the development and progression of chronic kidney disease and modifiable risk factor for renal diseases. Though an array of non-operative options are available for weight loss, these are associated with high failure rate. Bariatric surgery is considered as the most effective treatment as it may halt and/or reverse progressive loss of renal function even in obese patients with stage 3 chronic kidney disease.

Despite the favorable impact of bariatric surgery on glucose tolerance, hypertension, dyslipidemia and renal function, it has been associated with a significant risk of oxalosis. Oxalate nephropathy is one of the under-reported complications of bariatric surgery as it manifests a year or so after surgery. The outcome of oxalate nephropathy after Roux-en-Y gastric bypass (RYGB) is poor and may lead to end-stage renal disease (ESRD) in a proportion of patients. Hence, if a patient develops acute deterioration of renal functional after RYGB, the differential diagnosis shall include oxalate nephropathy and renal biopsy shall be considered earlier to establish the diagnosis.[2] Nasr et al.[3] have reported oxalate nephropathy after RYGB. The prognosis of oxalate nephropathy after RYGB seems to be dismal, with progression to ESRD within 3 months in 72.7% of patients as observed. Schuster et al.[4] stated that the main menace to renal function after bariatric surgery is a high frequency of hyperoxaluria, a risk factor for oxalate nephropathy, which varies from 8% to 42% respectively. This predisposition to develop high oxalate excretion rates incited Ahmed and Byrne[5] to point to the precarious balance after bariatric surgery between benefit and increased risk. Interestingly, similar complications were observed with orlistat, which reduces intestinal fat absorption and brings down body weight. Though cholestyramine binds oxalate at intestine and prevents its absorption, the results are variable. However, recent studies revealed that gastric banding does not cause hyperoxaluria, when compared to RYGB.

Unfortunately, there are no guidelines for the management of oxalate nephropathy after RYGB. However, improvement in renal function after reversal of bypass surgery is controversial and needs to be clarified. It is therefore suggested that patients undergoing RYGB shall be informed about the possibility of hyperoxaluria and oxalate nephropathy at the time of informed consent and counseled for long-term follow-up of renal function and periodical assessment of metabolic parameters along with dietary modifications to avert/minimize these risks. Extensive pre-operative preparations by the surgeons regarding diet, physical activity and life-style are vital to prevent this catastrophic complication. Discharge counseling and education shall include verbal and written instructions and the possibility of oxalate nephropathy. Further research is warranted in this area so as to establish evidence-based guidelines to decrease the risk of oxalate nephropathy after bariatric surgery.

References

  1. , , , . Oxalate nephropathy: An important cause of renal failure after bariatric surgery. Indian J Nephrol. 2013;23:316-8.
    [Google Scholar]
  2. , . Bariatric surgery and the kidney-much benefit, but also potential harm. Clin Kidney J. 2013;6:368-72.
    [Google Scholar]
  3. , , , , , , . Oxalate nephropathy complicating Roux-en-Y Gastric Bypass: An underrecognized cause of irreversible renal failure. Clin J Am Soc Nephrol. 2008;3:1676-83.
    [Google Scholar]
  4. , , , , , , . Effect of bariatric surgery on normal and abnormal renal function. Surg Obes Relat Dis. 2011;7:459-64.
    [Google Scholar]
  5. , , . Bariatric surgery and renal function: A precarious balance between benefit and harm. Nephrol Dial Transplant. 2010;25:3142-7.
    [Google Scholar]

    Fulltext Views
    53

    PDF downloads
    33
    View/Download PDF
    Download Citations
    BibTeX
    RIS
    Show Sections