Bariatric surgery and kidney disease outcomes in severely obese youth.

Bariatric surgery, an emerging treatment for severely obese youth with and without T2D, provides marked improvement in insulin resistance, beta-cell function, and central adiposity. Further, preliminary data suggest that bariatric surgery also results in significant improvement in markers of obesity-related nephropathy and DKD, beyond that which can be achieved with current medical interventions. Yet, the mechanisms whereby bariatric surgery attenuates kidney disease remain unclear. This review summarizes the data on the effects of bariatric surgery on obesity-related nephropathy and DKD in youth with and without T2D, in addition to potential mechanisms underlying the nephroprotective effects of weight loss surgery and how these may differ in Roux-en-Y gastric bypass vs. vertical sleeve gastrectomy. Finally, we discuss potential future non-surgical therapies to mitigate kidney disease.