Serra A, Romero R, Lopez D, Navarro M, Esteve A, Perez N, Alastrue A, Ariza A
Department of Nephrology, Hospital Universitari Germans Trias i Pujol, Autonomous University of Barcelona, Badalona, Barcelona, Spain.
Kidney Int. 2008 Apr;73(8):947-55. doi: 10.1038/sj.ki.5002796. Epub 2008 Jan 23.
We studied the glomerular architecture in renal biopsies of 95 patients undergoing bariatric surgery for extreme obesity but whose renal function was normal. The comparison group was 40 control patients having protocol biopsies. These latter patients had normal weight and renal function, were non-diabetic, non-hypertensive, and were undergoing nephrectomy or donating a kidney. Logistic regression models determined associations between the clinical and biochemical variables and glomerular lesions. Arterial hypertension, sleep apnea syndrome (SAS), and microalbuminuria were prevalent in the obese patients, as was hyperglycemia to a lesser extent. Focal and segmental glomerulosclerosis was present in only five extremely obese (EO) patients but absent in controls. Increased mesangial matrix, podocyte hypertrophy, mesangial cell proliferation, and glomerulomegaly were more frequent in the obese cohort than in the control group. Body mass index was a significant independent risk factor associated with glomerular lesions in all 135 patients and in the 95 EO patients, whereas SAS was associated with glomerulomegaly only in the EO. Our study shows that EO patients who lack overt clinical renal symptoms have a variety of glomerular abnormalities that correlate with body mass.
我们研究了95例接受减肥手术治疗极度肥胖但肾功能正常患者的肾活检肾小球结构。对照组为40例接受方案活检的对照患者。后一组患者体重和肾功能正常，无糖尿病、高血压，正在接受肾切除术或捐献肾脏。逻辑回归模型确定了临床和生化变量与肾小球病变之间的关联。动脉高血压、睡眠呼吸暂停综合征（SAS）和微量白蛋白尿在肥胖患者中很常见，高血糖在较小程度上也很常见。仅5例极度肥胖（EO）患者存在局灶节段性肾小球硬化，而对照组中未发现。肥胖队列中系膜基质增加、足细胞肥大、系膜细胞增殖和肾小球肿大比对照组更常见。体重指数是所有135例患者和95例EO患者中与肾小球病变相关的显著独立危险因素，而SAS仅在EO患者中与肾小球肿大相关。我们的研究表明，缺乏明显临床肾脏症状的EO患者存在多种与体重相关的肾小球异常。
