Diabetic kidney disease in patients with type 2 diabetes strongly correlates with the incidence of major cardiovascular events and\nall-causemortality. Pharmacological and lifestyle based management focusing on glycaemic, lipid, and blood pressure control is the\nmainstay of treatment but efficacy remains limited. Roux en Y gastric bypass is an efficacious intervention in diabetes. Emerging\nevidence also supports a role for bypass as an intervention for early diabetic kidney disease. This paper firstly presents level 1\nevidence of the effects of bypass on hyperglycaemia and hypertension and then summarises emerging data on its effects on diabetic\nkidney disease. Glucagon-like peptide-1 is implicated as a central mediator of diabetes resolution following bypass through the\nincretin effect. It has been ascribed vasodilatory, pronatriuretic, and antioxidant properties and its exogenous administration or\noptimisation of its endogenous levels via dipeptidyl peptidase IV inhibition results in antioxidant and antiproteinuric effects in\npreclinical models of DKD. Some evidence is emerging of translation of coherent effects in the clinical setting. These findings raise\nthe question of whether pharmacotherapy targeted at optimising circulating hormone levels may be capable of recapitulating some\nof the effects of bypass surgery on renal injury.
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