Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Curr Opin Nephrol Hypertens. 2010 Jan;19(1):37-42. doi: 10.1097/MNH.0b013e328332fc2b.
The obesity epidemic is undoubtedly increasing the total end-stage renal disease population, which has a larger proportion of obese individuals on reaching the dialysis stage. This review discusses recent advances in the pathophysiology of adipose tissue and adipokines that may contribute to increased risk of progression towards end-stage renal disease and cardiovascular damage.
Although leptin effects on blood pressure may negatively affect kidney function, leptin may also induce vascular damage through central and direct effects on both vessels and heart. The contradictory results of adiponectin in uremia are possibly confounded by the disease circumstances. Visfatin may have previously unrecognized roles in angiogenesis and nutrient homeostasis. As visfatin is a ubiquitously expressed enzyme, it may be inaccurate to refer to it as an adipokine.
We still face many unknowns when understanding the putative pleiotrophic effects that adipokines exert in the uremic milieu. Mechanistic and interventional studies are needed to move forward in this area. Conflicting results in patients with ESRD, in whom both beneficial and detrimental effects in uremia outcome are found, are perhaps the consequence of different timing or context-sensitive effects. Specifically, the presence of protein energy wasting and the changing pattern of disease risk may hinder or even reverse the natural action of these molecules.
肥胖症的流行无疑增加了终末期肾病患者的总人数，这些患者在进入透析阶段时肥胖人群的比例更大。这篇综述讨论了脂肪组织和脂肪因子的病理生理学的最新进展，这些进展可能导致进展为终末期肾病和心血管损害的风险增加。
尽管瘦素对血压的影响可能对肾功能产生负面影响，但瘦素也可能通过对血管和心脏的中枢和直接作用引起血管损伤。尿毒症中脂联素的矛盾结果可能与疾病情况有关。内脂素在血管生成和营养稳态中可能具有以前未被认识到的作用。由于内脂素是一种广泛表达的酶，因此将其称为脂肪因子可能并不准确。
在理解脂肪因子在尿毒症环境中可能发挥的多效性作用时，我们仍面临许多未知数。在这一领域需要进行机制和干预研究才能取得进展。在患有 ESRD 的患者中出现相互矛盾的结果，这些患者在尿毒症结果中既有有益作用也有有害作用，这可能是由于不同的时间或上下文敏感的作用。具体来说，蛋白质能量消耗的存在和疾病风险的变化模式可能会阻碍甚至逆转这些分子的自然作用。
