A Nephrologist Perspective on Obesity: From Kidney Injury to Clinical Management
Open Access
- 13 April 2021
- journal article
- review article
- Published by Frontiers Media SA in Frontiers in Medicine
Abstract
Obesity is one of the epidemics of our era. Its prevalence is higher than 30% in the U.S. and it is estimated to increase by 50% in 2030. Obesity is associated with a higher risk of all-cause mortality and it is known to be a cause of chronic kidney disease (CKD). Typically, obesity-related glomerulopathy (ORG) is ascribed to renal hemodynamic changes that lead to hyperfiltration, albuminuria and, finally, impairment in glomerular filtration rate due to glomerulosclerosis. Though not only hemodynamics are responsible for ORG: adipokines could cause local effects on mesangial and tubular cells and podocytes promoting maladaptive responses to hyperfiltration. Furthermore, hypertension and type 2 diabetes mellitus, two conditions generally associated with obesity, are both amplifiers of obesity injury in the renal parenchyma, as well as complications of overweight. As in the native kidney, obesity is also related to worse outcomes in kidney transplantation. Despite its impact in CKD and cardiovascular morbility and mortality, therapeutic strategies to fight against obesity-related CKD were limited for decades to renin-angiotensin blockade and bariatric surgery for patients who accomplished very restrictive criteria. Last years, different drugs have been approved or are under study for the treatment of obesity. Glucagon-like peptide-1 receptor agonists are promising in obesity-related CKD since they have shown benefits in terms of losing weight in obese patients, as well as preventing the onset of macroalbuminuria and slowing the decline of eGFR in type 2 diabetes. These new families of glucose-lowering drugs are a new frontier to be crossed by nephrologists to stop obesity-related CKD progression.Keywords
This publication has 128 references indexed in Scilit:
- A randomized, phase 3 trial of naltrexone SR/bupropion SR on weight and obesity‐related risk factors (COR‐II)Obesity, 2013
- Controlled‐Release Phentermine/Topiramate in Severely Obese Adults: A Randomized Controlled Trial (EQUIP)Obesity, 2012
- Inflammation, Oxidative Stress, and ObesityInternational Journal of Molecular Sciences, 2011
- Scope and mechanisms of obesity-related renal diseaseCurrent Opinion in Nephrology and Hypertension, 2010
- Lipid oversupply, selective insulin resistance, and lipotoxicity: Molecular mechanismsBiochimica et Biophysica Acta (BBA) - Molecular and Cell Biology of Lipids, 2010
- Interrelation Between Sex Hormones and Plasma Sex Hormone-Binding Globulin and Hemoglobin A1c in Healthy Postmenopausal WomenMetabolic Syndrome and Related Disorders, 2009
- Inflammation and endoplasmic reticulum stress in obesity and diabetesInternational Journal of Obesity, 2008
- Obesity and Cardiac Risk After Kidney Transplantation: Experience at One Center and Comprehensive Literature ReviewTransplantation, 2008
- Adiponectin regulates albuminuria and podocyte function in miceJCI Insight, 2008
- Obesity Impacts Access to Kidney TransplantationJournal of the American Society of Nephrology, 2008