New Pandemic: Obesity and Associated Nephropathy

Abstract

Incidence of obesity related renal disorders have increased 10-folds in recent years. One of the consequences of obesity is an increased glomerular filtration rate (GFR) that leads to the enlargement of the renal glomerulus, i.e., glomerulomegaly. This heightened hyper-filtration in the setting of type 2 diabetes irreparably damages the kidney and leads to progression of end stage renal disease (ESRD). The patients suffering from type 2 diabetes have progressive proteinuria, and eventually one third of them develop chronic kidney disease (CKD) and ESRD. For ameliorating the progression of CKD, inhibitors of renin angiotensin aldosterone system (RAAS) seemed to be effective, but on a short-term basis only. Long term and stable treatment strategies like weight loss via restricted or hypo-caloric diet or bariatric surgery have yielded better promising results in terms of amelioration of proteinuria and maintenance of normal GFR. Body mass index (BMI) is considered as a traditional marker for the onset of obesity, but apparently, it is not a reliable indicator, and thus there is a need for more precise evaluation of regional fat distribution and amount of muscle mass. With respect to the pathogenesis, recent investigations have suggested perturbation in fatty acid and cholesterol metabolism as the critical mediators in ectopic renal lipid accumulation associated with inflammation, increased generation of ROS, RAAS activation and consequential tubulo-interstitial injury. This review summarizes the renewed approaches for the obesity assessment and evaluation of the pathogenesis of CKD, altered renal hemodynamics and potential therapeutic targets.

Metabolic Syndrome-Related Kidney Injury: A Review and Update

“…Activation of the RAAS and enhanced sympathetic activity in obese patients lead to increased levels of aldosterone, which reflexively lead to increased renal tubular reabsorption of sodium salts, resulting in water and sodium retention (54). The activation of RAAS in obese patients leads to hemodynamic changes such as increased of GFR and renal plasma flow (RPF), which causes glomerular hyperfiltration, compensated glomerulomegaly, segmental sclerosis, and promoting the progression of MetSrelated renal damage (55)(56)(57). Hormone regulation disorder and ectopic lipid deposition in obese patients can directly or indirectly affect the structure and function of renal intrinsic cells (52).…”

Langfristige körperliche und psychische Folgen chronischer Nierenerkrankungen

“…Am häufigsten entstehen chronische Nierenerkrankungen infolge einer arteriellen Hypertonie, eines Diabetes mellitus oder einer Adipositas mit metabolischem Syndrom [ 16 , 17 ]. Eine frühzeitige und moderne Therapie ist gerade bei dieser Patient:innengruppe möglich und kann erfolgreich sein, das Stadium der terminalen Niereninsuffizienz zu vermeiden.…”

Higher Neutrophil-To-Lymphocyte Ratio Was Associated with Increased Risk of Chronic Kidney Disease in Overweight/Obese but Not Normal-Weight Individuals

“…Serum concentrations of inflammatory markers are elevated in patients with CKD compared with those with normal kidney function, and they are associated with worsening kidney function in the general population [3,4]. Furthermore, many studies have demonstrated that body mass index (BMI, kg/m 2 ) is a potential predictor of proteinuria, glomerular filtration rate (eGFR) decline, and development of end-stage renal disease [5][6][7]. The increased risk for CKD among obese individuals, in addition to the underlying cardiometabolic abnormalities, can be due to excess adiposity-associated chronic inflammatory process, which contributes to early pathogenic mechanisms of kidney injury [7].…”

“…Furthermore, many studies have demonstrated that body mass index (BMI, kg/m 2 ) is a potential predictor of proteinuria, glomerular filtration rate (eGFR) decline, and development of end-stage renal disease [5][6][7]. The increased risk for CKD among obese individuals, in addition to the underlying cardiometabolic abnormalities, can be due to excess adiposity-associated chronic inflammatory process, which contributes to early pathogenic mechanisms of kidney injury [7]. However, some studies reported negative roles of obesity for CKD on an inflammatory basis [8][9][10].…”