Praga Manuel, Morales Enrique
Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain.
Contrib Nephrol. 2006;151:221-229. doi: 10.1159/000095332.
The level of proteinuria is one of the most determinant risk factors for the progression of proteinuric renal diseases. Several studies have shown that weight loss, either induced by low calorie diets, physical exercise, or bariatric surgery is accompanied by an important antiproteinuric effect. Reduction in proteinuria is already observed after a few weeks from the onset of weight loss and it is evident even in patients with modest weight losses. The magnitude of body weight loss and proteinuria decrease show a significant correlation. Reduction in proteinuria by weight loss has been described in obesity-induced glomerulopathy, obese diabetic patients and overweight or obese patients with different types of chronic proteinuric nephropathies. Attenuation of the obesity-induced glomerular hyperfiltration, decrease in the activity of renin-angiotensin-aldosterone system and modifications in the serum concentrations of adipocyte-derived cytokine are likely to be involved in the anti-proteinuric effect of weight loss, together with a better control of blood pressure, and improvement of serum lipid profile and insulin sensitivity.
蛋白尿水平是蛋白尿性肾脏疾病进展的最具决定性的危险因素之一。多项研究表明，通过低热量饮食、体育锻炼或减肥手术引起的体重减轻伴随着重要的抗蛋白尿作用。体重减轻开始几周后即可观察到蛋白尿减少，即使是体重减轻幅度不大的患者也是如此。体重减轻的幅度与蛋白尿减少之间存在显著相关性。体重减轻导致蛋白尿减少已在肥胖相关性肾小球病、肥胖糖尿病患者以及患有不同类型慢性蛋白尿性肾病的超重或肥胖患者中得到描述。肥胖引起的肾小球高滤过的减轻、肾素 - 血管紧张素 - 醛固酮系统活性的降低以及脂肪细胞衍生细胞因子血清浓度的改变，可能与体重减轻的抗蛋白尿作用有关，同时还能更好地控制血压、改善血脂谱和胰岛素敏感性。
