Severe Hypoalbuminemia Following Roux-En-Y Gastric Bypass in a Patient with Type 1 Diabetes

E. Krzizek
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Abstract

Albuminuria in the context of diabetic nephropathy is a known complication of poorly controlled diabetes. Data of the Swedish Obese Study showed a reduction of albuminuria after bariatric surgery. On the other hand, Roux-en-Y gastric bypass carries the risk of protein malabsorption due to changes in the gut anatomy and physiology. In this case report we describe the results of a patient with both, diabetes mellitus type 1 and bariatric surgery. A 49-year old woman (height 157cm, weight 95kg, BMI 38.5kg/ m 2 ) with type 1 diabetes since 1983 underwent Roux-en-Y gastric bypass in 2005. She was admitted to our hospital due to generalized edema in December 2017. Routine check-up for bariatric patients was performed including blood tests after an overnight fasting and a urine sample. Amongst others HbA1c, creatinine, albumin and albumin-creatinine-ratio were evaluated. Yearly check-ups of these parameters were evaluated retrospectively since 1999. As expected, there was a significant weight loss after bariatric surgery (2005: 122kg, BMI 49.4kg/m 2 ; 2007: 80kg, BMI 32.4kg/m 2 ). Diabetes control has always been poor (HbA1c 8.9% (1999), 8.7% (2005), 10.3% (2007), 10.8% (2017)). Diabetic nephropathy and retinopathy have been known since 1999. Albuminuria was present before bariatric surgery and got worse over the years (ACR 32.6mg/g (1999), 158mg/g (2005), 2246.4mg/g (2014), 1336.1mg/g (2017). Furthermore, hypalbuminemia has been present before surgery and deteriorated subsequently (albumin 29.0% (1999), 60.6% (2005), 32.2% (2012), 21.6% (2017)). In this patient, albuminuria unexpectedly worsened after Roux-en-Y gastric bypass despite weight loss, most likely due to insufficient metabolic control. Following surgery, decreased protein absorption contributed to the severe hypoalbuminemia resulting in generalized edema. Thus, patients at high risk for hypoalbuminemia, especially those with progressive diabetic nephropathy, need to be carefully evaluated preoperatively and be offered non-malabsorptive bariatric procedures such as sleeve gastrectomy, if indicated.
1型糖尿病患者Roux-En-Y胃旁路术后严重低白蛋白血症
蛋白尿在糖尿病肾病的背景下是一个已知的并发症控制不良的糖尿病。瑞典肥胖研究的数据显示,减肥手术后蛋白尿减少。另一方面,Roux-en-Y胃旁路术由于肠道解剖和生理的改变而存在蛋白质吸收不良的风险。在这个病例报告中,我们描述了一个同时患有1型糖尿病和减肥手术的病人的结果。一名49岁女性(身高157cm,体重95kg, BMI 38.5kg/ m2),自1983年以来患有1型糖尿病,于2005年行Roux-en-Y胃旁路手术。于2017年12月因全身性水肿入住我院。对肥胖患者进行常规检查,包括禁食一夜后的血液检查和尿样。评估HbA1c、肌酐、白蛋白和白蛋白-肌酐比值。自1999年以来,每年对这些参数进行回顾性检查。正如预期的那样,减肥手术后体重明显减轻(2005年:122kg, BMI 49.4kg/ m2;2007年:80公斤,体重指数32.4公斤/平方米)。糖尿病控制一直较差(HbA1c 8.9%(1999), 8.7%(2005), 10.3%(2007), 10.8%(2017))。自1999年以来,糖尿病肾病和视网膜病变已为人所知。在减肥手术前存在蛋白尿,并且随着时间的推移而恶化(ACR 32.6mg/g (1999), 158mg/g (2005), 2246.4mg/g (2014), 1336.1mg/g(2017))。此外,手术前存在低白蛋白血症并在手术后恶化(白蛋白29.0%(1999年),60.6%(2005年),32.2%(2012年),21.6%(2017年))。本例患者在Roux-en-Y胃旁路手术后,尽管体重减轻,但蛋白尿意外恶化,很可能是由于代谢控制不足。手术后,蛋白质吸收减少导致严重的低白蛋白血症,导致全身性水肿。因此,低白蛋白血症高危患者,尤其是进行性糖尿病肾病患者,术前需要仔细评估,如有必要,可进行非吸收不良减肥手术,如袖式胃切除术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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