Glomerular hemodynamics in severe obesity

Chagnac, Avry; Weinstein, Talia; Korzets, Asher; Ramadan, Edward; Hirsch, Judith A.; Gafter, Uzi

doi:10.1152/ajprenal.2000.278.5.f817

Cited by 545 publications

(414 citation statements)

References 26 publications

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“…In a study of 12 non-diabetic participants with severe obesity (BMI >38 kg/m 2 ) and nine non-obese participants, GFR measured by inulin clearance was 136±8 and 90±5 ml/min, respectively (p<0.0005) [35]. In another study by the same group, GFR determined by inulin clearance in eight participants with severe obesity decreased from 145±14 to 110±7 ml/min 12 months after gastroplasty, with a concomitant 32% decrease in BMI [36].…”

Section: Hyperfiltration Independent Of Diabetesmentioning

confidence: 94%

The clinical significance of hyperfiltration in diabetes

et al. 2010

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Glomerular filtration rate is commonly elevated in early diabetes and patients with this symptom are arbitrarily considered to have hyperfiltration. The prevalence of hyperfiltration in type 1 diabetes varies from less than 25% to more than 75%. The corresponding figures in type 2 diabetes are significantly lower, ranging between 0% and more than 40%. Several factors, methodological and biological, may contribute to the wide variation in estimates of hyperfiltration prevalence. Methodological differences in measurement and evaluation of GFR apply in particular to the handling of plasma disappearance curves of filtration markers. Biological factors that may influence GFR in the hyperfiltration range include glycaemic control, diabetes duration, BMI, sex, pubertal status in type 1 diabetes and age in type 2 diabetes. Hyperglycaemia may influence GFR and albuminuria, and may therefore confound the evaluation of hyperfiltration as an independent risk factor for diabetic nephropathy. Adequate assessment of the relationship between glycaemic control, GFR and AER therefore requires serial measurements of all three variables followed by multivariate analysis. A recent meta-analysis of ten type 1 diabetes studies concluded that the presence of hyperfiltration at baseline more than doubled the risk of developing micro-or macroalbuminuria at follow-up. However, not all studies allowed for confounding factors or regression dilution bias. Future studies will therefore need to address the independent role of hyperfiltration, not only in the evolution of albuminuria, but also in the subsequent decline of GFR.

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Section: Hyperfiltration Independent Of Diabetesmentioning

confidence: 94%

The clinical significance of hyperfiltration in diabetes

et al. 2010

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“…Alterations in renal homeostatic mechanisms have also been associated with the MS and its features (5)(6)(7). Sodium and uric acid retention are linked to insulin resistance (7)(8)(9), whereas a renal hyperhemodynamic state has been ascribed to obesity (10). Moreover, an association between MS and chronic kidney disease (CKD) was recently described; patients with increasing features of the MS had a greater incidence and prevalence of CKD (11,12).…”

mentioning

confidence: 99%

Low Urine pH

Maalouf

Cameron

Moe

et al. 2007

Clinical Journal of the American Society of Nephrology

258

180

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Background and Objectives: The metabolic syndrome is associated with alterations in renal function. An overly acidic urine has been described as a renal manifestation of the metabolic syndrome in patients with kidney stone disease. This study examined the association between the metabolic syndrome and urine pH in individuals without a history of nephrolithiasis.Design, Setting, Participants, & Measurements: A total of 148 adults who were free of kidney stones were evaluated in this outpatient cross-sectional study. Height, weight, BP, fasting blood, and 24-h urine chemistries were obtained. Urine pH was measured by pH electrode. The following features of the metabolic syndrome were evaluated: BP; body mass index; and serum triglyceride, glucose, and HDL cholesterol concentrations. The degree of insulin resistance was assessed by the homeostasis model assessment of insulin resistance.Results: Participants with the metabolic syndrome had a significantly lower 24-h urine pH compared with participants without the metabolic syndrome. Mean 24-h urine pH, adjusted for age, gender, creatinine clearance, and 24-h urine sulfate, decreased from 6.15, 6.10, 5.99, 5.85, to 5.69 with increasing number of metabolic syndrome abnormalities. An association was observed between 24-h urine pH and each metabolic feature. After adjustment for age, gender, creatinine clearance, urine sulfate, and body mass index, a significant inverse relationship was noted between 24-h urine pH and the degree of insulin resistance.Conclusions: An unduly acidic urine is a feature of the metabolic syndrome and is associated with the degree of insulin resistance.

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“…Consequently, the afferent arterioles are dilated resulting in increase in renal blood blow, intraglomerular pressure, and GFR [8,14]. This explains the underlying mechanism of obesity induced hyperfiltration, which is the first manife- The extracted studies mostly use estimated GFR and the creatinine clearance as the kidney function parameters.…”

Section: Discussionmentioning

confidence: 99%

“…Many experimental and clinical data indicate that obesity results in glomerular hyperfiltration; however, the pathophysiologic mechanism is unknown [8]. Hyperfiltration leads to the occurrence of microalbuminuria and proteinuria and can accelerate the progression of preexisting renal failure [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Can Bariatric Surgery Be a Surgical Treatment to Prevent the Progression of Chronic Kidney Disease?

Choi

2016

J Metab Bariatr Surg

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Obesity is a serious worldwide health problem causing numerous obesity-related comorbidities such as hyperlipidemia, hypertension, diabetes, and cardiovascular dysfunctions. Recently, many studies indicate that obesity is strongly related with high rate of renal lesions and reducing weight with surgical intervention can improve renal parameters in obese patients, but the effect of bariatric surgery on obesity-induced chronic kidney disease (CKD) is hardly documented. This review study shows that bariatric surgery demonstrates beneficial reduction in proteinuria and albuminuria leading to improve both glomerular hyperfiltration and chronic kidney disease in obese population. Yet, bariatric surgery is not a definite treatment of choice for the obese patients with CKD because of lack of evidence explaining the risk of complications following bariatric surgery and clarification on estimating glomerular filtration rate (eGFR) in obese patients. Future, high quality studies with a long term follow up are required to determine the effective durability of bariatric surgery on obese-related CKD patients.

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Glomerular hemodynamics in severe obesity

Cited by 545 publications

References 26 publications

The clinical significance of hyperfiltration in diabetes

The clinical significance of hyperfiltration in diabetes

Low Urine pH

Can Bariatric Surgery Be a Surgical Treatment to Prevent the Progression of Chronic Kidney Disease?

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