Fatty kidney: A possible future for chronic kidney disease research

Abstract

Background: Metabolic syndrome is a growing twenty-first century pandemic associated with multiple clinical comorbidities ranging from cardiovascular diseases, non-alcoholic fatty liver disease and polycystic ovary syndrome to kidney dysfunction. A novel area of research investigates the concept of fatty kidney in the pathogenesis of chronic kidney disease, especially in patients with diabetes mellitus or metabolic syndrome. Aim: To review the most updated literature on fatty kidney and provide future research, diagnostic and therapeutic perspectives on a disease increasingly affecting the contemporary world. Materials and Method: We performed an extensive literature search through three databases including Embase (Elsevier) and the Cochrane Central Register of Controlled Trials (Wiley) and PubMed/Medline Web of Science in November 2021 by using the following terms and their combinations: 'fatty kidney', 'ectopic fat', 'chronic kidney disease', 'cardiovascular event', 'cardio-metabolic risk', 'albuminuria' and 'metabolic syndrome'. Each study has been individually assessed by the authors.Results: Oxidative stress and inflammation, Klotho deficiency, endoplasmic reticulum stress, mitochondrial dysfunction and disruption of cellular energy balance appear to be the main pathophysiological mechanisms leading to tissue damage following fat accumulation. Despite the lack of large-scale comprehensive studies in this novel field of research, current clinical trials demonstrate fatty kidney as an independent risk factor for the development of chronic kidney disease and cardiovascular events. Conclusion:The requirement for future studies investigating the pathophysiology, clinical outcomes and therapeutics of fatty kidney is clear.

Donor obesity and weight gain after transplantation: two still overlooked threats to long-term graft survival

“…Abdominal obesity and higher BMI have been linked to fatty kidney, a recently identified area of research implicating adipose tissue accumulation in renal sinus and perirenal tissues [ 10 ]. Fatty kidney predisposes individuals to the development of chronic kidney disease (CKD) via various pathophysiological mechanisms, most of which are applicable to kidney transplantation from obese or overweight donors.…”

Thyroid hormone Beta receptor agonists for treatment of kidney disease: A promising agent?

“…Fatty kidney, referring to the accumulation of perirenal adipose tissue including renal sinus has been associated with high serum total cholesterol, high very low-density lipoprotein cholesterol (VLDL cholesterol), high LDL cholesterol, high fasting plasma glucose or HbA1c, high gamma-glutamyl transferase, low high-density lipoprotein (HDL) cholesterol levels and certain medical comorbidities including diabetes mellitus, hypertension and metabolic syndrome. 89 Two major hypothesis explaining the association between fatty kidney and CKD have been proposed. First, accumulation of perirenal adipose tissue leads to inflammation and oxidative stress either by direct secretion of cytokines from adipose tissue or by an inflammatory response that may lead to damage at renal tubular epithelium, podocytes, glomerular structure and renal vasculature.…”

“…A recently identified condition, fatty kidney, may be the key in the understanding of CKD and potentially may become the reason why TR‐β agonists is helpful in the management of CKD. Fatty kidney, referring to the accumulation of perirenal adipose tissue including renal sinus fat, has been associated with high serum total cholesterol, high very low‐density lipoprotein cholesterol (VLDL cholesterol), high LDL cholesterol, high fasting plasma glucose or HbA1c, high gamma‐glutamyl transferase, low high‐density lipoprotein (HDL) cholesterol levels and certain medical comorbidities including diabetes mellitus, hypertension and metabolic syndrome 89 . Two major hypothesis explaining the association between fatty kidney and CKD have been proposed.…”