Obesity‐related glomerulopathy: Current approaches and future perspectives

Abstract

Summary Obesity‐related glomerulopathy (ORG) is a silent comorbidity which is increasing in incidence as the obesity epidemic escalates. ORG is associated with serious health consequences including chronic kidney disease, end‐stage renal disease (ESRD), and increased mortality. Although the pathogenic mechanisms involved in the development of ORG are not fully understood, glomerular hemodynamic changes, renin‐angiotensin‐aldosterone system (RAAS) overactivation, insulin‐resistance, inflammation and ectopic lipid accumulation seem to play a major role. Despite albuminuria being commonly used for the non‐invasive evaluation of ORG, promising biomarkers of early kidney injury that are emerging, as well as new approaches with proteomics and metabolomics, might permit an earlier diagnosis of this disease. In addition, the assessment of ectopic kidney fat by renal imaging could be a useful tool to detect and evaluate the progression of ORG. Weight loss interventions appear to be effective in ORG, although large‐scale trials are needed. RAAS blockade has a renoprotective effect in patients with ORG, but even so, a significant proportion of patients with ORG will eventually progress to ESRD despite therapeutic efforts. It is noteworthy that certain antidiabetic agents such as sodium‐glucose cotransporter 2 inhibitors (SGLT2i) or glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) could be useful in the treatment of ORG through different pleiotropic effects. In this article, we review current approaches and future perspectives in the care and treatment of ORG.

Effects and Clinical Value of Peritoneal Dialysis on Water and Water Balance, Adverse Reactions, Quality of Life, and Clinical Prognosis in Patients with Decompensated Chronic Nephropathy: A Systematic Review and Meta-Analysis

“…In recent years, some studies have compared the survival rates of the two dialysis methods, but the conclusions are controversial. It has been reported that in the early stage of dialysis, the survival rate of PD patients is better than that of HD patients [ 6 ]. Other studies show that the survival rates of the two groups of dialysis patients are similar [ 7 ].…”

Visceral fat and attribute-based medicine in chronic kidney disease

“…Increased visceral fat accumulation is also accompanied with perirenal and renal sinus fat accumulation, which causes high intrarenal pressure, which leads to compression of the vasa recta capillaries and thin loops of Henle, reduced blood flow in the renal medulla, increased sodium reabsorption in the loop of Henle, RAAS activation, and increased sodium reabsorption ( 50 , 53 , 54 ). These pathological conditions interact in a complex manner, ultimately damaging the kidneys by causing glomerular hyperfiltration ( 55 , 56 ) and inflammation ( 57 , 58 ), both of which are characteristics of obesity-related kidney disease ( 50 , 53 , 54 , 59 – 61 ).…”

Obesity and renal disease: Benefits of bariatric surgery

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