RESUMEN
BACKGROUND AND AIMS: Obesity is a worldwide pandemic with multiple consequences including kidney affection. This study aimed to assess the effects of obesity on renal functions and to detect the most reliable formula of estimated glomerular filtration rate (eGFR) in morbidly obese patients. METHODS: A cross-sectional, observational study was conducted on 82 morbidly obese patients. Anthropometric measurements were done for all patients and body adiposity (BAI) and visceral adiposity (VAI) indices were calculated after assessment of abdominal fat tissue analysis by computerized tomography (CT). Serum creatinine was incorporated into six different formulae of eGFR, then eGFR was compared with the 24-h measured creatinine clearance (CLcr) values. RESULTS: The mean body mass index was 55.8 ± 9.5 kg/m2. Proteinuria and glomerular hyperfiltration (CLcr > 130 ml/min/1.73 m2) were detected in 68.3% and 91.5% of the patients, respectively. Cockcroft-Gault formula using total (CCG-TBW-eGFR) and adjusted body water (CCG-AjBW-eGFR) had the nearest values to measured CLCr. These two formulae had a moderate reliability and the lowest percentage of error (30% and 23%, respectively). Visceral and total abdominal fat tissue surface area and volume assessed by CT were directly correlated to the 24-h urinary protein excretion (r = 0.32, 0.24, 0.37 and 0.34, respectively; p = 0.02, 0.03, 0.004 and 0.002, respectively). CONCLUSIONS: Glomerular hyperfiltration and proteinuria are highly prevalent in morbidly obese patients. There is no ideal formula for GFR estimation in morbidly obese patients, however, TBW and AjBW incorporated into the Cockcroft-Gault can be helpful in those patients.
Asunto(s)
Índice de Masa Corporal , Tasa de Filtración Glomerular , Enfermedades Renales/patología , Obesidad Mórbida/fisiopatología , Adulto , Creatinina/sangre , Estudios Transversales , Egipto/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Enfermedades Renales/sangre , Enfermedades Renales/epidemiología , Masculino , Pronóstico , Reproducibilidad de los ResultadosRESUMEN
PURPOSE: Obesity is a major health problem with many renal sequelae. Bariatric surgery (BS) has become the treatment of choice for severe obesity. This study was conducted to assess the short-term renal effects of BS and to compare such effects between two distinct forms of BS. MATERIALS AND METHODS: A single-center non-randomized prospective observational study was conducted on 57 patients with severe obesity. Two distinct forms of BS have been performed; laparoscopic sleeve gastrectomy (LSG) and laparoscopic one anastomosis gastric bypass (OAGB). Anthropometric measurements, 24-h urinary creatinine clearance (CLCr), protein and oxalate excretion, and abdominal fat tissue analysis by computerized tomography were performed prior to surgery and 6 months later. RESULTS: LSG and OAGB were performed in 47 and 10 participants, respectively. BS resulted in pronounced reduction of body mass index (- 27.1% ± 7.11), with no substantial weight loss discrepancy between LSG and OAGB. The median percent change in 24-h urinary CLCr and protein and oxalate excretion were - 35.7, - 42.2, and - 5.8, respectively. The median (IQR) percent change of urinary oxalate excretion was - 11.1 (- 22.6, - 1.4) and 113.08 (82.5, 179.7) for LSG and OAGB, respectively (p < 0.001). The subcutaneous abdominal fat surface area has been found to be the significant predictor of the persistence of glomerular hyperfiltration after BS. CONCLUSION: Both LSG and OAGB can alleviate many of the obesity-related pathological renal changes. However, postoperative hyperoxaluria remains a serious issue particularly in OAGB. Detailed radiological abdominal fat tissue analysis by CT may aid in predicting the renal outcome following BS.
Asunto(s)
Cirugía Bariátrica , Derivación Gástrica , Laparoscopía , Obesidad Mórbida , Egipto/epidemiología , Gastrectomía , Humanos , Obesidad Mórbida/cirugía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND/AIMS: The aim of this study was to evaluate the importance of concomitant caudate lobe resection in the course of major hepatectomy for hilar cholangiocarcinoma. METHODOLOGY: During the period between January 1995 and December 2010, 159 patients were subjected to major hepatectomy with or without total caudate lobe resection at the Gastroenterology Centre, Mansoura University. These patients were divided in two groups: 1) a caudate lobe preservation (CLP) group (79 patients) and 2) a caudate lobe resection (CLR) group (80 patients). All patient data were retrospectively reviewed. RESULTS: This study included 94 men and 65 women with a mean age of 53.5±0 years without operative mortality. No differences were observed between groups regarding operative time, blood loss or the development of any individual postoperative complication. There were 23 (28.8%) margin-positive resections in the CLR group and 49 (62%) margin-positive resections in the CLP group (p≤0.001). Recurrence was confirmed in 53 (67.1%) and in 41(51.3%) patients in the CLP and CLR groups, respectively (p=0.031). The median survival of the CLR group was 36 months with a 5-year survival rate of 28%, while the median survival of the CLP group was 22 months with a 5-year survival rate of 5% (p≤0.001). CONCLUSIONS: Caudate lobe resection in combination with major hepatectomy did not affect operative or postoperative morbidity and mortality. However, it led to higher rates of margin-negative resections and significantly improved survival.