The Altered Structure of Renal Papillary Outflow Tracts in Obesity

Dwyer, Terry; Bigler, Steven A.; Moore, N. A.; Carroll, Joan F.; Hall, John E.

doi:10.1080/01913120050176707

Cited by 18 publications

(15 citation statements)

References 14 publications

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“…Compression of blood vessels, lymph vessels, and ureters in the RS (sinus lipomatosis)24 may obstruct the renal outflow tract and increase intrarenal hydrostatic pressure 25. As a result, kidney size may increase.…”

Section: Discussionmentioning

confidence: 99%

Renal Sinus Fat and Poor Blood Pressure Control in Middle-Aged and Elderly Individuals at Risk for Cardiovascular Events

et al. 2010

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Fat in the renal sinus (RS), a region of the kidney in which low pressure venous and lymphatic vessels are present, may indirectly influence blood pressure (BP). The purpose of this study was to assess the association between RS fat and control of BP upon receipt of antihypertensive medications. Two hundred-five (205) participants aged 55 to 85 years at risk for cardiovascular (CV) events underwent magnetic resonance imaging assessments of abdominal and RS fat, measurement of blood pressure, and determination of the number of prescribed antihypertensive medications. Multivariable linear regression was used to determine associations between RS fat, blood pressure, and the number of prescribed antihypertensive medications. Abdominal fat averaged (416 ± 160 cm3, median and interquartile range (IQR) of 396 cm3 and 308 to 518 cm3); intraperitoneal (IP) fat averaged (141 ± 73 cm3, median and IQR of 129 cm3 and 86 to 194 cm3); and RS fat averaged (4.6 ± 3.2 cm3, median and IQR of 4.2 cm3 and 2.2 to 6.6 cm3). After accounting for age, gender, height, body mass index (BMI), and IP fat, RS fat correlated with the number of prescribed antihypertensive medications (p=0.010), stage II hypertension (p=0.02), and renal size (p=<0.001). In conclusion, after accounting for other body fat depots and risk factors for hypertension, renal sinus fat volume is associated with the number of prescribed antihypertensive medications and stage II hypertension. These results indicate that further studies are warranted to determine if fat accumulation in the renal sinus promotes hypertension.

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Section: Discussionmentioning

confidence: 99%

Renal Sinus Fat and Poor Blood Pressure Control in Middle-Aged and Elderly Individuals at Risk for Cardiovascular Events

et al. 2010

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“…95,96 Fat accumulation in the kidneys was associated with glomerulosclerosis and proteinuria with increased expression of sterol regulatory element binding protein. 97 Thus, renal sinus fat or fatty kidney may induce structural and functional damage in the kidney and subsequently increase systemic vascular resistance and cardiovascular risk.…”

Section: Fat Around Kidneymentioning

confidence: 99%

Links Between Ectopic Fat and Vascular Disease in Humans

Lim

Meigs

2014

ATVB

169

130

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The average of overweight individual can have differential fat depots in target-organs or specific compartments of the body. This ectopic fat distribution may be more of a predictive factor for cardiovascular risk than obesity. Abdominal visceral obesity, a representative ectopic fat, is robustly associated with insulin resistance and cardiovascular risk. Fat depots in the liver and muscle tissue cause adverse cardiometabolic risk by affecting glucose and lipid metabolism. Pericardial fat and perivascular fat affect coronary atherosclerosis, cardiac function, and hemodynamics. Fat around the neck is associated with systemic vascular resistance. Fat around the kidney may increase blood pressure and induce albuminuria. Fat accumulation in or around the pancreas alters glucose metabolism, conferring cardiovascular risk. Ectopic fat may act as an active endocrine and paracrine organ that releases various bioactive mediators that influence insulin resistance, glucose and lipid metabolism, coagulation, and inflammation, which all contribute to cardiovascular risk. As both obese and apparently lean individuals can have ectopic fat, regional fat distribution may play an important role in the development of cardiovascular diseases in both non-obese and obese people.

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“…Increased numbers of interstitial cells and an increase in material rich in lipids and proteoglycans compresses the renal parenchyma toward the pole of the kidney resulting in the formation of round-shaped, enlarged kidneys in obese subjects. 29,30 Renal compression affects both vascular (mainly the vasa recta) and tubular (the Henle's loops) elements causing activation of the RAS and increased sodium reabsorption.…”

Section: Structural Changes In the Kidneymentioning

confidence: 99%

Mechanisms of obesity-induced hypertension

et al. 2010

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The relationship between obesity and hypertension is well established both in children and adults. The mechanisms through which obesity directly causes hypertension are still an area of research. Activation of the sympathetic nervous system has been considered to have an important function in the pathogenesis of obesity-related hypertension. The arterial-pressure control mechanism of diuresis and natriuresis, according to the principle of infinite feedback gain, seems to be shifted toward higher blood-pressure levels in obese individuals. During the early phases of obesity, primary sodium retention exists as a result of increase in renal tubular reabsorption. Extracellular-fluid volume is expanded and the kidney-fluid apparatus is resetted to a hypertensive level, consistent with a model of hypertension because of volume overload. Plasma renin activity, angiotensinogen, angiotensin II and aldosterone values display significant increase during obesity. Insulin resistance and inflammation may promote an altered profile of vascular function and consequently hypertension. Leptin and other neuropeptides are possible links between obesity and the development of hypertension. Obesity should be considered as a chronic medical condition, which is likely to require long-term treatment. Understanding of the mechanisms associated with obesity-related hypertension is essential for successful treatment strategies. Hypertension Research (2010) 33, 386-393; doi:10.1038/hr.2010.9Keywords: leptin; obesity; pressure natriuresis; rennin-angiotensin-aldosterone system; sympathetic nervous system INTRODUCTION Obesity is a common disorder that develops from the interaction between the genotype and the environment and involves social, behavioral, cultural, physiological, metabolic and genetic factors. A large number of studies have shown that obesity has an important negative impact on health in a population, leading to the recommendation for general practitioners to have an important function in the management of this condition and of its associated comorbidities such as hypertension, hyperlipidemia and hyperinsulinemia/insulin resistance. The relationship between obesity and hypertension is well established both in adults and children. 1,2 Obese individuals exhibit higher levels of office as well as ambulatory blood pressure (BP) from childhood to old age. Obese subjects display higher BP levels than non-obese individuals even in the normotensive range. The combination of obesity, hypertension and other cardiovascular risk factors significantly increases the probability of adverse cardiovascular outcomes, and raises considerations for aggressive treatment strategies. 3 The mechanisms through which obesity directly causes hypertension are still an area of research. Human and animal studies have elucidated the function of adipose tissue derivatives (adipokines and cytokines), neurohumoral pathways, metabolic functions and modulation of pressor/depressor mechanisms. Although obesity-related hypertension may be the result of a combinatio...

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The Altered Structure of Renal Papillary Outflow Tracts in Obesity

Cited by 18 publications

References 14 publications

Renal Sinus Fat and Poor Blood Pressure Control in Middle-Aged and Elderly Individuals at Risk for Cardiovascular Events

Renal Sinus Fat and Poor Blood Pressure Control in Middle-Aged and Elderly Individuals at Risk for Cardiovascular Events

Links Between Ectopic Fat and Vascular Disease in Humans

Mechanisms of obesity-induced hypertension

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