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2011 Revista Nefrologa. rgano Oficial de la Sociedad Espaola de Nefrologa
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Nefrologia 2011;31(4):397-403
doi:10.3265/Nefrologia.pre2011.M ay.10963
ABSTRACT
INTRODUCTION
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Table 1. Co-morbidit ies associat ed w it h overw eight
and obesit y
1. Diabetes
2. Hypertension
3. M etabolic syndrome
4. Cardiovascular disease
5. Cancer
6. Osteoarthritis
7. Gall bladder disease
8. Non-alcoholic liver disease
9. Pancreatitis
10. Obstructive sleep apnea
11. Depression
12. Chronic kidney disease
Pathologic
Glomerulomegaly
Glomerulosclerosis
Obesity related glomerulopathy
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Direct evidence for a detrimental effect of obesity on kidney
disease comes from the study of specific diseases such as IgA
nephritis, where excessive body weight (BMI >
_25) at the time
of kidney biopsy was shown to be associated with the
severity of the detected pathologic lesions, the subsequent rate
of loss of kidney function, and to be an independent risk
factor for progression to ESRD41,47. Similar results have been
observed on the onset of proteinuria and progressive loss of
kidney function after unilateral nephrectomy in obese
individuals48. At the 20-year follow up of this study, most of
the normal non-obese individuals had normal kidney
function as compared to only about 40% of the expected
GFR for age in the obese subjects. These observations are
more dramatically evident in kidney transplant recipients. In
an analysis of a large registry database (51927 kidney
transplant recipients), it was shown that the relative risk of
graft loss, patient death, and cardiovascular mortality
increased49 by 20-40% at increasing BMIs of over 30 kg/m2.
As a result, a BMI of over 35 kg/m2 has come to be considered
a contraindication to kidney transplantation in some centers.
The detrimental effect of overweight on the course of CKD is
supported by several epidemiologic studies that show a higher
prevalence and increasing incidence of obesity in patients with
ESRD being initiated on dialysis50. In a study of over 300,000
subjects, the presence of obesity was shown to increase the
relative risk of ESRD, adjusted for confounding factors45. Once
again, this relationship was not related to obesity bi-modally,
but showed an incremental continuum related to increased BMI
that was statistically significant at BMI values of >25.
Compared to lean subjects, the relative risk of ESRD was 3.57
for those with a BMI of 30-34.9, 6.12 for those with a BMI of
35-39.9, and 7.07 for those with morbid obesity (BMI >40)45.
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Table 3. Fact ors implicat ed in t he pat hogenesis
of CKD in obesit y
Renin angiotensin system
Aldosterone
Sympathetic nervous system
Insulin resistance
Salt intake
Altered adepokines
Leptin
Fetuin-A
Resistin
Adenopectin
Tumor necrosis factor-
Free fatty acids
M S: metabolic syndrome; HBP: high blood pressure; DM : diabetes
mellitus; CVD: cardiovascular disease; CKD: chronic kidney disease.
Endothelin-1
Brain natriuretic protein
Plasminogen activator inhibitor-1
Infiltrating macrophage phenotypic sw itch
CONCLUSION
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addition, the presence of obesity amplifies the risk for and
outcomes of chronic kidney disease in diabetes,
hypertension, metabolic syndrome, primary kidney diseases,
and cardiovascular disease (Figure 1). Given the evidence
for the potential reversibility of these detrimental obesityrelated hemodynamic effects and the proteinuria of obesity
on progression of kidney diseases and their outcomes,
weight reduction (dietary or bariatric surgery) should be
considered a component of the therapeutic regimen of all
overweight individuals with CKD30,31.
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