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.

1. WORLD KIDNEY DAY
2017

2. OBESITY
&
RENAL FAILURE
PROF. MANOHAR LAL DAWANI
Professor of Nephrology

3. DEFINITION OF OBESITY
 Derived from word OBESUS meaning
To Devour (eating)
 determined by weight and height ratio
 Body Mass Index (BMI)= kg/m2

4. DEGREES OF OBESITY
NORMAL
BMI 18.5 – 24.9
OVERWEIGHT
BMI 25 – 29.9
OBESE
BMI 30 – 34.9
SEVERE OBESE
BMI 35 – 39.9
MORBIDLY
OBESE
BMI  40

5. MEDICAL IMPLICATIONS
 hypertension
 hyperlipidemia
 diabetes mellitus
 respiratory
insufficiency
 obesity-
hypoventilation
 sleep apnea
 Asthma
 Renal Failure
 cardiomyopathy/MI
 GERD
 PE/DVT
 CVA
 stress incontinence
 Arthritis wt-bearing
joints
 low back pain
 venous stasis/ulcers
 cholelithiasis
 amenhorrhea
 infertility problems
 skin
infections/inflammation
 accident proneness
- cancer (uterus, breast,
colon, prostate)

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

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

14. SLEEVE GASTRECTOMY

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)

16. Laparoscopic Roux en Y Gastric Bypass

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

18. Study
Mortality
with Surgery
Mortality
without Surgery
MacDonald, 1997 9% 28%
Christou, 2004 0.7% 6.1%
O’Brien, 2006 0.3% 10.6%
Surgery Decreases Long-term Mortality

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