Obesity Surgery

, Volume 29, Issue 11, pp 3581–3588 | Cite as

Albuminuria in Patients with Morbid Obesity and the Effect of Weight Loss Following Bariatric Surgery

  • Johanna Maria Brix
  • Carsten Thilo Herz
  • Hans Peter Kopp
  • Astrid Feder
  • Eva-Christina Krzizek
  • Christoph Sperker
  • Gerit-Holger Schernthaner
  • Guntram Schernthaner
  • Bernhard LudvikEmail author
Original Contributions


Background and Objectives

Patients with morbid obesity are at an increased risk for cardiovascular and renal complications, which are not only linked to traditional cardiovascular risk factors. Thus, we evaluated (a) the prevalence of albuminuria in non-diabetic and diabetic morbidly obese patients and (b) the effect of weight loss following bariatric surgery.

Material and Methods

We included 1307 patients (77% women, mean age 40 ± 12 years, BMI 45.6 ± 6.6 kg/m2) in a cross-sectional study. A subgroup (n = 318) was followed up for 2 years after bariatric surgery. Weight, cardiovascular risk markers and a 75-g glucose tolerance test were determined. Albuminuria was assessed by collecting 24-h urine on three consecutive days.


In the cross-sectional study, the prevalence of microalbuminuria was 16.0% (n = 209), of macroalbuminuria 3.1% (n = 41). The chi-square for the association of albuminuria and diabetes was 31.937 (p < 0.001). Of all patients with albuminuria, 42.0% exhibited normal glucose tolerance. In a multivariate regression analysis, systolic blood pressure (beta = 0.236; p < 0.001), log fasting insulin (beta = 0.309; p < 0.001) and log 2-h postprandial insulin (beta = − 0.173; p = 0.033) were predictive risk factors for albuminuria. Longitudinally, albumin excretion decreased significantly from 11.1 (6.4, 18.4 mg/24 h) to 7.8 mg/24 h (4.9, 13.0 mg/24 h; p < 0.001). In the group with albuminuria preoperatively, albumin excretion decreased from 65.7 (38.2, 147.1 mg/24 h) to 13.5 mg/24 h (8.4, 36.8 mg/24 h; p < 0.001). After adjusting for age, sex and baseline albuminuria, patients with lower creatinine clearance showed a smaller decrease of albuminuria (beta = 0.117; p = 0.021).


A substantial portion of patients with morbid obesity exhibits microalbuminuria, nearly half of those present with normal glucose tolerance. After weight loss, we found a significant decrease of albuminuria, potentially indicating or even contributing to the known reduction of cardiovascular mortality after bariatric surgery.


Albuminuria Weight loss Morbid obesity Bariatric surgery 



We thank E Lobersiner and B Markl for the important contribution for this work.

Compliance with Ethical Standards

The study was approved by the institutional ethics committee and complies with the Declaration of Helsinki including current revisions and the Good Clinical Practice guidelines. The procedures performed were in accordance with institutional guidelines and all subjects gave written informed consent before the study.

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    WHO obesity and overweight. Fact sheet N°311; May 2012:
  2. 2.
    Hossain P, Kawar B, El Nahas M. Obesity and diabetes in the developing world- as growing challenge. N Engl J Med. 2007;356(3):213–5.CrossRefGoogle Scholar
  3. 3.
    Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357:753–61.CrossRefGoogle Scholar
  4. 4.
    Sjöström L, Narbo K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–5.CrossRefGoogle Scholar
  5. 5.
    Maestro A, Rigla M, Caixàs A. Does bariatric surgery reduce cancer risk? A review of the literature. Endocrinol Nutr. 2015;62(3):138–43.CrossRefGoogle Scholar
  6. 6.
    Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes - 5-year outcomes. N Engl J Med. 2017;376(7):641–51.CrossRefGoogle Scholar
  7. 7.
    Hsu CY, McCulloch CE, Iribarren C, et al. Body mass index and risk for end-stage renal disease. Ann Intern Med. 2006;144(1):21–8.CrossRefGoogle Scholar
  8. 8.
    Serra A, Romero R, Lopez D, et al. Renal injury in the extremely obese patients with normal renal function. Kidney Int. 2008;73(8):947–55.CrossRefGoogle Scholar
  9. 9.
    Serra A, Esteve A, Navarro-Díaz M, et al. Long-term normal renal function after drastic weight reduction in patients with obesity-related glomerulopathy. Obes Facts. 2015;8(3):188–99.CrossRefGoogle Scholar
  10. 10.
    Carlsson LM, Romeo S, Jacobson P, et al. The incidence of albuminuria after bariatric surgery and usual care in Swedish Obese Subjects (SOS): a prospective controlled intervention trial. Int J Obes. 2015;39(1):169–75.CrossRefGoogle Scholar
  11. 11.
    Chang AR, Chen Y, Still C, et al. Bariatric surgery is associated with improvement in kidney outcomes. Kidney Int. 2016;90(1):164–71.CrossRefGoogle Scholar
  12. 12.
    Navarro-Díaz M, Serra A, Romero R, et al. Effect of drastic weight loss after bariatric surgery on renal parameters in extremely obese patients: long-term follow-up. J Am Soc Nephrol. 2006;17(12 Suppl 3):S213–7.CrossRefGoogle Scholar
  13. 13.
    Agrawal V, Khan I, Rai B, et al. The effect of weight loss after bariatric surgery on albuminuria. Clin Nephrol. 2008;70(3):194–202.CrossRefGoogle Scholar
  14. 14.
    Agrawal V, Krause KR, Chengelis DL, et al. Relation between degree of weight loss after bariatric surgery and reduction in albuminuria and C-reactive protein. Surg Obes Relat Dis. 2009;5(1):20–6.CrossRefGoogle Scholar
  15. 15.
    Navaneethan SD, Kelly KR, Sabbagh F, et al. Urinary albumin excretion, HMW adiponectin, and insulin sensitivity in type 2 diabetic patients undergoing bariatric surgery. Obes Surg. 2010;20(3):308–15.CrossRefGoogle Scholar
  16. 16.
    Heneghan HM, Cetin D, Navaneethan SD, et al. Effects of bariatric surgery on diabetic nephropathy after 5 years of follow-up. Surg Obes Relat Dis. 2013;9(1):7–14.CrossRefGoogle Scholar
  17. 17.
    Hofsø D, Nordstrand N, Johnson LK, et al. Obesity-related cardiovascular risk factors after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention. Eur J Endocrinol. 2010;163(5):735–45.CrossRefGoogle Scholar
  18. 18.
    Mohan S, Tan J, Gorantla S, et al. Early improvement in albuminuria in non-diabetic patients after Roux-en-Y bariatric surgery. Obes Surg. 2012;22(3):375–80.CrossRefGoogle Scholar
  19. 19.
    Chagnac A, Weinstein T, Herman M, et al. The effects of weight loss on renal function in patients with severe obesity. JASN. 2003;14:1480–6.CrossRefGoogle Scholar
  20. 20.
    Amor A, Jiménez A, Moizé V, et al. Weight loss independently predicts urinary albumin excretion normalization in morbidly obese type 2 diabetic patients undergoing bariatric surgery. Surg Endosc. 2013;27(6):2046–51.CrossRefGoogle Scholar
  21. 21.
    de Zeeuw D, Parving HH, Henning RH. Microalbuminuria as an early marker for cardiovascular disease. JASN. 2006;17(8):2100–5.CrossRefGoogle Scholar
  22. 22.
    Matsuda M, de Fronzo R. Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care. 1999;22(9):1462–70.CrossRefGoogle Scholar
  23. 23.
    Salazar DE, Corcoran GB. Predicting creatinine clearance and renal drug clearance in obese patients from estimated fat-free body mass. Am J Med. 1988;84(6):1053–60.CrossRefGoogle Scholar
  24. 24.
    Hallan H, Romundstad S, Kvenild K, et al. Microalbuminuria in diabetic and hypertensive patients and the general population--consequences of various diagnostic criteria--the Nord-Trøndelag Health Study (HUNT). Scand J Urol Nephrol. 2003;37(2):151–8.CrossRefGoogle Scholar
  25. 25.
    Seo WJ, Lee GM, Hwang JH, et al. Association between body mass index, waist circumference and prevalence of microalbuminuria in Korean adults of age 30 years and older without diabetes, hypertension, renal failure, or overt proteinuria: the 2013 Korean National Health and Nutrition Examination Survey. Korean J Fam Med. 2016;37:57–6.CrossRefGoogle Scholar
  26. 26.
    Sung KC, Ryu S, Lee JY, et al. Urine albumin/creatinine ratio below 30 mg/g is a predictor of incident hypertension and cardiovascular mortality. J Am Heart Assoc. 2016;5(9)Google Scholar
  27. 27.
    Tanaka F, Komi R, Makita S, et al. Low-grade albuminuria and incidence of cardiovascular disease and all-cause mortality in nondiabetic and normotensive individuals. J Hypertens. 2016;34(3):506–12.CrossRefGoogle Scholar
  28. 28.
    Arnlov J, Evans JC, Meigs JB, et al. Low-grade albuminuria and incidence of cardiovascular disease events in nonhypertensive and nondiabetic individuals: the Framingham Heart Study. Circulation. 2005;112:969–75.CrossRefGoogle Scholar
  29. 29.
    Kambham N, Markowitz G, Valeri A, et al. Obesity-related glomerulopathy: an emerging epidemic. Kidney Int. 2001;59:1498–509.CrossRefGoogle Scholar
  30. 30.
    Eknoyan G. Obesity, diabetes and chronic kidney disease. Curr Diabet Rep. 2007;7:449–53.CrossRefGoogle Scholar
  31. 31.
    Câmara NO, Iseki K, Kramer H, et al. Kidney disease and obesity: epidemiology, mechanisms and treatment. Nat Rev Nephrol. 2017;13(3):181–90.CrossRefGoogle Scholar
  32. 32.
    Garofalo C, Borrelli S, Minutolo R, et al. A systematic review and meta-analysis suggests obesity predicts onset of chronic kidney disease in the general population. Kidney Int. 2017;91:1224–35.CrossRefGoogle Scholar
  33. 33.
    Weir MR, Fink JC. Salt intake and progression of chronic kidney disease: an overlooked modifiable exposure? A commentary. Am J Kidney Dis. 2005;45(1):176–88.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Johanna Maria Brix
    • 1
    • 2
  • Carsten Thilo Herz
    • 3
  • Hans Peter Kopp
    • 1
    • 2
  • Astrid Feder
    • 1
    • 2
  • Eva-Christina Krzizek
    • 1
    • 2
  • Christoph Sperker
    • 4
  • Gerit-Holger Schernthaner
    • 5
  • Guntram Schernthaner
    • 1
  • Bernhard Ludvik
    • 1
    • 2
    Email author
  1. 1.Department of Medicine IRudolfstiftung HospitalViennaAustria
  2. 2.Karl Landsteiner Institute for Obesity and Metabolic DisordersViennaAustria
  3. 3.Department of Medicine III, Division of EndocrinologyMedical University of ViennaViennaAustria
  4. 4.Department of SurgeryRudolfstiftung HospitalViennaAustria
  5. 5.Department of Medicine II, Division of AngiologyMedical University of ViennaViennaAustria

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