Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
Clin J Am Soc Nephrol. 2010 Aug;5(8):1401-9. doi: 10.2215/CJN.01370210. Epub 2010 May 24.
Obesity-related glomerulopathy (ORG) is an increasing cause of end-stage renal disease, but evidence concerning the effects of treatments is rather limited. This study was aimed at exploring the renoprotective effects of weight loss on patients with ORG.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A total of 63 patients with renal biopsy-proven ORG had food and exercise intervention in the physician-supervised weight loss program and were divided into three groups on the basis of the percentage of weight change from baseline to follow-up: significant weight loss (>3% reduction in body mass index [BMI]), stable weight, or significant weight gain (>3% increase). Metabolic parameters and renal lesions were evaluated regularly for 2 years.
After 6 months, 27 patients lost weight by 8.29 +/- 4.00%, with a mean decrease in proteinuria of 35.3%, whereas 24 months later, 27 patients achieved a 9.20 +/- 3.78% reduction in BMI and a 51.33% reduction in urine protein secretion. The levels of serum triglyceride, serum uric acid, and BP were also decreased. Contrarily, in patients with increased BMI, urine protein was increased by 28.78%. Correlation analysis showed proteinuria was associated with BMI, serum triglyceride, and uric acid, and multivariate regression analysis indicated the changes in BMI were the only predictor of proteinuria (P < 0.01).
Weight loss intervention benefited remission of proteinuria in patients with ORG, whose function could not be replaced by conventional pharmacotherapy.
肥胖相关性肾小球病（ORG）是导致终末期肾病的一个日益增多的原因，但关于治疗效果的证据相当有限。本研究旨在探讨减肥对 ORG 患者的肾脏保护作用。
设计、设置、参与者和测量：共有 63 例经肾活检证实的 ORG 患者在医生监督下的减肥计划中接受饮食和运动干预，并根据体重从基线到随访的变化百分比分为三组：体重显著减轻（体重指数[BMI]降低>3%）、体重稳定或体重显著增加（BMI 增加>3%）。定期评估代谢参数和肾脏病变 2 年。
6 个月后，27 例患者体重减轻 8.29±4.00%，蛋白尿平均减少 35.3%，24 个月后，27 例患者 BMI 降低 9.20±3.78%，尿蛋白分泌减少 51.33%。血清甘油三酯、尿酸和血压水平也降低。相反，在 BMI 增加的患者中，尿蛋白增加了 28.78%。相关分析显示蛋白尿与 BMI、血清甘油三酯和尿酸有关，多元回归分析表明 BMI 的变化是蛋白尿的唯一预测因素（P<0.01）。
体重减轻干预有益于 ORG 患者蛋白尿的缓解，其功能不能被传统的药物治疗所替代。
