Role of Obesity in the Progression of Diabetic Nephropathy in Patients with Diabetes Mellitus (Literature Review)
The prevalence of obesity has risen proportionally to epidemic and continues to be a major health problem worldwide. The high prevalence of obesity is closely associated with the increased incidence of chronic diseases, such as diabetes mellitus, hypertension and cardiovascular diseases. Obesity, as well as diabetes mellitus and hypertension, is the main cause of chronic kidney disease and end-stage renal disease. The presence of at least one of these risk factors increases the overall risk of developing the disease. The pathophysiology of diabetic nephropathy and renal diseases associated with obesity are nearly identical. In addition, they lead to the development of successive changes, from an increase in glomerular filtration rate and intraglomerular capillary pressure to glomerular hypertrophy and microalbuminuria. Increased systolic blood pressure further aggravates the process and causes the disease progression to proteinuria, nodular glomerulosclerosis, tubulointerstitial renal disease and reduced glomerular filtration rate leading to the development of end-stage renal failure. White adipose tissue — not only a fat storage organ, but also is now recognized as a dynamic tissue involved in the production of adipokines, such as leptin, adiponectin, etc. The balance between these adipokines allows adipose tissue to regulate appetite, food intake, glucose clearance, energy expenditure. Imbalance in obesity stimulates an inflammatory environment and leads to insulin resistance. Kidney disease related to obesity is associated with disorders of renal hemodynamics, dysfunction of endothelium and podocytes, damage to the glomerular basement membrane, mesangial expansion, tubular atrophy, interstitial fibrosis and progressive decline in renal function (increased albuminuria and decreased glomerular filtration rate) leading to the development of end-stage renal disease. Nevertheless, there is no clear understanding of the mechanisms, by which the obesity alone or in conjunction with type 2 diabetes and hypertension contributes to the development
and/or progression of chronic kidney disease and end-stage renal failure.
Full Text:PDF (Русский)
Foster MC, Hwang SJ, Larson MG, et al. Overweight, obesity, and the development of stage 3 CKD: the Framingham Heart Study. Am J Kidney Dis. 2008 Jul;52(1):39–48.
Hsu CY, McCulloch CE, Iribarren C, Darbinian J, Go AS. Body mass index and risk for end-stage renal disease. Ann Intern Med. 2006 Jan 3;144(1):21–28.
Ejerblad E, Fored CM, Lindblad P, Fryzek J, McLaughlin JK, Nyren O. Obesity and risk for chronic renal failure. J Am SocNephrol. 2006 Jun;17(6):1695–1702.
Praga M, Morales E. Obesity, proteinuria and progression of renal failure. CurrOpinNephrol Hypertens.2006 Sep;15(5):481–486.
Wang Y, Chen X, Song Y, Caballero B, Cheskin LJ. Association between obesity and kidney disease: a systematic review and meta-analysis. Kidney Int. 2008 Jan;73(1):19–33.
Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006 Apr 5;295(13):1549–1555.
Health UNIo. Atlas of End-stage renal disease in the United States. Annualreport. 2009
WHO. Obesity and overweight fact sheet. 2015http://www.who.int/mediacentre/factsheets/fs311/en/index.html.
Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999–2010. JAMA. 2012 Feb 1;307(5):483–490.
Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA. 2012 Feb 1;307(5):491–497.
Global status report on noncommunicable diseases 2014. Geneva, World Health Organization, 2012.
Kramer H, Luke A, Bidani A, Cao G, Cooper R, McGee D. Obesity and prevalent and incident CKD: the Hypertension Detection and Follow-Up Program. Am J Kidney Dis. 2005 Oct;46(4):587–594.
Munkhaugen J, Lydersen S, Wideroe TE, Hallan S. Prehypertension, obesity, and risk of kidney disease: 20-year follow-up of the HUNT I study in Norway. Am J Kidney Dis. 2009 Oct;54(4):638–646.
Hall JE, Kuo JJ, da Silva AA, de Paula RB, Liu J, Tallam L. Obesity-associated hypertension and kidney disease. CurrOpinNephrolHypertens. 2003 Mar;12(2):195–200.
Esler M, Rumantir M, Wiesner G, Kaye D, Hastings J, Lambert G. Sympathetic nervous system and insulin resistance: from obesity to diabetes. Am J Hypertens. 2001 Nov;14(11 Pt 2):304S–309S.
Blanco S, Bonet J, Lopez D, Casas I, Romero R. ACE inhibitors improve nephrin expression in Zucker rats with glomerulosclerosis. Kidney Int Suppl. 2005 Jan;(93):S10–S14.
Chagnac A, Herman M, Zingerman B, et al. Obesity-induced glomerular hyperfiltration: its involvement in the pathogenesis of tubular sodium reabsorption. Nephrol Dial Transplant. 2008 Dec;23(12):3946–3952.
Jauregui A, Mintz DH, Mundel P, Fornoni A. Role of altered insulin signaling pathways in the pathogenesis of podocyte malfunction and microalbuminuria. CurrOpinNephrolHypertens. 2009 Nov;18(6):539–545.
de Boer IH, Sibley SD, Kestenbaum B, et al. Central obesity, incident microalbuminuria, and change in creatinine clearance in the epidemiology of diabetes interventions and complications study. J Am SocNephrol. 2007 Jan;18(1):235–243.
Eijkelkamp WB, Zhang Z, Remuzzi G, et al. Albuminuria is a target for renoprotective therapy independent from blood pressure in patients with type 2 diabetic nephropathy: post hoc analysis from the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) trial. J Am SocNephrol. 2007 May;18(5):1540–1546.
Klausen KP, Parving HH, Scharling H, Jensen JS. Microalbuminuria and obesity: impact on cardiovascular disease and mortality. ClinEndocrinol (Oxf) 2009 Jul;71(1):40–45.]
Praga M, Morales E. Obesity-related renal damage: changing diet to avoid progression. Kidney Int. 2010 Oct;78(7):633–635.
Mohan S, Tan J, Gorantla S, Ahmed L, Park CM. Early improvement in albuminuria in non-diabetic patients after Roux-en-Y bariatric surgery. Obes Surg. 2012 Mar;22(3):375–380.
Ritz E, Koleganova N, Piecha G. Is there an obesity-metabolic syndrome related glomerulopathy? CurrOpinNephrolHypertens. 2011 Jan;20(1):44–49.
King GL. The role of inflammatory cytokines in diabetes and its complications. J Periodontol. 2008 Aug;79(8 Suppl):1527–1534.
Tang J, Yan H, Zhuang S. Inflammation and oxidative stress in obesity-related glomerulopathy. Int J Nephrol. 2012;2012 608397.
Saraheimo M, Forsblom C, Thorn L, et al. Serum adiponectin and progression of diabetic nephropathy in patients with type 1 diabetes. Diabetes Care. 2008 Jun;31(6):1165–1169.
This work is licensed under a Creative Commons Attribution 4.0 International License.
© "Publishing House "Zaslavsky", 1997-2018