NEPHROLOGY
The Comeback
Kidneys
Why does bariatric surgery help protect the kidneys in severely obese youth with type 2 diabetes ?
Treatment methods to impede diabetic kidney disease in obese youth with type 2 diabetes are largely ineffective , save for one : weight loss surgery . Endocrinologist Petter Bjornstad , MD , is working to find out why that is and if there ’ s a way to leverage its effects for patients who can ’ t have surgery .
According to a U . S . renal data system report from 2016 , diabetic kidney disease continues to be the leading cause of renal failure in the United States , accounting for approximately 45 % of all cases that progress to end-stage and dialysis . At a time when other common causes of end-stage kidney disease are not increasing in prevalence , says Petter Bjornstad , MD , that information is particularly disturbing , because it means more people — more adolescents — are developing type 2 diabetes . And compared to adult-onset type 2 , youth-onset type 2 is markedly more difficult to treat .
“ We don ’ t know why ,” Dr . Bjornstad says , “ but youth with type 2 have a more aggressive phenotype with greater insulin resistance and more rapid beta cell failure . They also have a higher rate of complications including diabetic kidney disease . And not only higher rates , but also earlier onset . That ’ s scary .”
Is surgical therapy a more effective treatment method for diabetic kidney disease than medical therapy in severely obese adolescents with type 2 diabetes ?
Cohort
Severely obese adolescents with type 2 diabetes
BMI > 35
93 patients across two cohorts after frequency matching for race , sex , age , ethnicity
10 | CHILDREN ’ S HOSPITAL COLORADO