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.
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