Ross Will R, McGill Janet B
Washington University School of Medicine, St. Louis, MO 63110, USA.
Adv Chronic Kidney Dis. 2006 Oct;13(4):325-35. doi: 10.1053/j.ackd.2006.07.012.
The obesity epidemic has reached nephrology in the form of increasing numbers of patients with chronic kidney disease (CKD) caused by obesity-related metabolic disorders, IgA nephropathy, stone disease, and a unique glomerulopathy now known as obesity-related glomerulopathy (ORG). Obesity has been identified as an independent risk factor for CKD, and patients with central adiposity or high waist-to-hip ratios appear to have the highest risk. The metabolic syndrome is a risk factor for albuminuria and CKD, and studies now show that the risk of CKD increases with increased numbers of components of the metabolic syndrome. Obesity is not just a bystander or accelerator of other kidney diseases, but has unique histopathologic characteristics that can cause progressive kidney disease. ORG may accompany and worsen IgA nephropathy, urate nephropathy, and possibly even diabetic nephropathy. The origins of obesity-related kidney disease can be traced to insufficient glomerular complement from birth, and low birth weight may be an important precursor to obesity and its many comorbidities. Intervention strategies may need to target prenatal care through the elderly to combat this problematic epidemic.
肥胖流行已波及肾脏病领域，表现为因肥胖相关代谢紊乱、IgA肾病、结石病以及一种现称为肥胖相关肾小球病（ORG）的独特肾小球病导致的慢性肾脏病（CKD）患者数量不断增加。肥胖已被确定为CKD的独立危险因素，中心性肥胖或高腰臀比的患者似乎风险最高。代谢综合征是蛋白尿和CKD的危险因素，现在研究表明，随着代谢综合征组成成分数量的增加，CKD的风险也会增加。肥胖不仅是其他肾脏疾病的旁观者或加速器，还具有可导致进行性肾脏疾病的独特组织病理学特征。ORG可能伴随并加重IgA肾病、尿酸盐肾病，甚至可能加重糖尿病肾病。肥胖相关肾脏疾病的起源可追溯到出生时肾小球补体不足，低出生体重可能是肥胖及其许多合并症的重要先兆。干预策略可能需要针对从产前护理到老年人的整个阶段，以应对这一有问题的流行病。
