title: Improvements in the metabolic milieu following Roux-en-Y gastric bypass and the arrest of diabetic kidney disease.
abstract: Roux-en-Y gastric bypass (RYGB) is an efficacious intervention for morbid obesity and has a diabetes-remitting effect in patients with obesity and type 2 diabetes mellitus, which occurs prior to significant weight loss. Roux-en-Y gastric bypass is also associated with early and sustained reductions in the risk factor profile for the progression of diabetic complications. Attention is therefore now being placed on RYGB as a metabolic intervention with the capacity to yield therapeutic benefit in relation to the progression of diabetic complications, such as diabetic kidney disease. As alterations in gut anatomy following RYGB coincide with attendant shifts in downstream enteroendocrine signals with direct and indirect resolutionary effects on the kidney, the concept of an endocrine gut-kidney axis post-RYGB is growing. With the model of a gut-kidney axis in mind, this article summarizes emerging data on the effects of RYGB on risk factors for diabetic kidney disease (hyperglycaemia, dyslipidaemia and hypertension), highlighting a potential role for glucagon-like peptide 1 in risk factor reduction.
authors.affiliation: Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Belfield, Dublin 4, Ireland neil.docherty@ucd.ie.
authors.forename: Neil G
authors.initials: NG
authors.lastname: Docherty
authors.affiliation: Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Belfield, Dublin 4, Ireland Gastrosurgical Laboratory, University of Gothenburg, Gothenburg, Sweden Investigative Science, Imperial College London, London, UK.
authors.forename: Carel W
authors.initials: CW
authors.lastname: le Roux
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D018450:Disease Progression; D019858:Enteroendocrine Cells / Q000378:metabolism; D015390:Gastric Bypass; D006801:Humans; D007668:Kidney / Q000378:metabolism / Q000503:physiopathology; D008055:Lipids / Q000097:blood; D009765:Obesity / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D012074:Remission Induction; D012307:Risk Factors; D015398:Signal Transduction; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D008055:Lipids