The document discusses obesity and its relationship to renal failure. It defines obesity based on Body Mass Index (BMI) and describes its various degrees. Obesity is linked to numerous medical implications including hypertension, diabetes, respiratory issues, and renal failure. Obese individuals often experience structural, hemodynamic and metabolic changes to the kidneys over time. These changes can eventually lead to renal failure if not addressed. The document also discusses bariatric surgery options for weight loss such as gastric banding, sleeve gastrectomy, and gastric bypass, and how they work to restrict food intake and digestion to help control obesity-related conditions and reduce mortality risks over time.
6. Obesity is a U.S. public health epidemic:
64% Americans overweight
30% Americans obese
10% morbidly obese
400,000 deaths /year from obesity related causes
[90,000 deaths/yr from colon + breast ca]
#2 cause of preventable deaths
#1 is smoking
PAKISTAN ---- # 9 in World Obesity Index
7.
8.
9. EFFECTS ON KIDNEY
Obesity causes various structural, hemodynamic and
metabolic alterations
Mostly due to compensatory response to increased body
mass
Renal failure is usually secondary to failure of chronic
compensation
10. RENAL CHANGES
Increase in the GFR
Kidney weight increases secondary to Glomerular
hypertrophy
Systemic Hypertension
Increased salt sensitivity
RAA system activation
Diabetes
11. OBESITY RELATED GLOMERULOPATHY
Non Hypertensive & Non diabetic renal changes
Specific to Obesity without apparent comorbidity
Characterised by :
Proteinuria
FSGS
10% - 30% progress to End Stage Renal Disease
12. PREDISPOSING FACTORS
Visceral Body Fat
Metabolic Syndrome
Obesity Associated Conditions
Low Nephron Number
Nephron Mass Reduction
Progressive loss of functioning nephrons
13. How does surgery work?
Restrictive - restrict amount of food ingested
Decreases appetite/hunger
Early satiety
Behavior modification
Gastric Banding (Lap Band)
Sleeve Gastrectomy
Malabsorptive- limits digestion and absorption
Decreases length of intestine exposed to digested food
25% of fat is absorbed
Behavior modification
Biliopancreatic Diversion, Duodenal Switch (BPD/DS)
Combination- Roux-En-Y Gastric Bypass
All operations can be performed open or laparoscopically
15. The Laparoscopic Adjustable
Gastric Band System (LAGB)
A silicone band is placed
around the upper part of the
stomach
A small pouch is created
Slows down gastric pouch
emptying
Early feeling of satiety
Surgical appetite suppressant
Purely restrictive
Quick recovery
Adjustable restriction
through mediport
Reversible (if necessary)
Depends on surgeon and
patient commitment (much
f/u)
17. Surgery Deters Progression of Illness
0
10
20
30
40
50
2 YR 10 YR 2 YR 10 YR 2 YR 10 YR
8
24
29
49
22
27
1
7
20
35
8 10
Incidence (%)
DM HTN TG
Control
Surgery
Sjöström et al., NEJM 2004,352:2683
19. The Goal is to be Healthy
55 – 70% of the excess weight off
Feeling less tired and sick
Relief from multiple medications especially for
Hypertension, Dyslipidemias
Control and possible remission of Diabetes