Bondar' I A, Klimontov V V, Simakova A I
Ter Arkh. 2011;83(6):66-70.
Obesity and overweight are now characterized as epidemics. It is shown that body overweight is associated with functional and structural changes in the kidneys. The results of epidemiological studies indicate that obesity can be the risk factor of chronic kidney disease (CKD) irrespective of the presence or absence of diabetes, arterial hypertension and other comorbidities. Manifestations of renal pathology in obese persons include microalbuminuria and proteinuria, hyperfiltration or impaired renal function. Glomerulomegaly and focal segmental glomerulosclerosis are the most typical structural signs of obesity-related nephropathy. More evidence is accumulated on the link between CKD in obesity and abnormalities in adypokine secretion (hyperleptinemia, lack of adiponectin), activation of rennin-angiotensin system, chronic inflammation, endothelial dysfunction, lipid accumulation, impaired renal hemodynamics and diminished nephron number related to body mass. A decrease of body weight following lifestyle modification or bariatric surgery leads to reduction in albuminuria and eliminates hyperfiltration in obese subjects. Thus, prevention and treatment of obesity may reduce CKD incidence in general population.
肥胖和超重如今被视为流行病。研究表明，体重超标与肾脏的功能和结构变化有关。流行病学研究结果表明，无论是否存在糖尿病、动脉高血压及其他合并症，肥胖都可能是慢性肾脏病（CKD）的危险因素。肥胖人群肾脏病理表现包括微量白蛋白尿和蛋白尿、超滤过或肾功能受损。肾小球肥大和局灶节段性肾小球硬化是肥胖相关性肾病最典型的结构特征。关于肥胖中的慢性肾脏病与脂肪因子分泌异常（高瘦素血症、脂联素缺乏）、肾素 - 血管紧张素系统激活、慢性炎症、内皮功能障碍、脂质蓄积、肾血流动力学受损以及与体重相关的肾单位数量减少之间的联系，已有更多证据积累。通过生活方式改变或减重手术减轻体重可使肥胖受试者的蛋白尿减少并消除超滤过。因此，预防和治疗肥胖可能会降低普通人群中慢性肾脏病的发病率。
