Litwin Mieczysław, Niemirska Anna
Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland,
Pediatr Nephrol. 2014 Feb;29(2):203-16. doi: 10.1007/s00467-013-2500-1. Epub 2013 Jun 13.
Visceral obesity and metabolic abnormalities typical for metabolic syndrome (MS) are the new epidemic in adolescence. MS is not only the risk factor for cardiovascular disease but also for chronic kidney disease (CKD). Thus, there are some reasons to recognize MS as a new challenge for pediatric nephrologists. First, hypertensive and diabetic nephropathy, the main causes of CKD in adults, both share the same pathophysiological abnormalities associated with visceral obesity and insulin resistance and have their origins in childhood. Secondly, as the obesity epidemic also affects children with CKD, MS emerges as the risk factor for progression of CKD. Thirdly, metabolic abnormalities typical for MS may pose additional risk for cardiovascular morbidity and mortality in children with CKD. Finally, although the renal transplantation reverses uremic abnormalities it is associated with an exposure to new metabolic risk factors typical for MS and MS has been found to be the risk factor for graft loss and cardiovascular morbidity after renal transplantation. MS is the result of imbalance between dietary energy intake and expenditure inducing disproportionate fat accumulation. Thus, the best prevention and treatment of MS is physical activity and maintenance of proper relationship between lean and fat mass.
内脏肥胖以及代谢综合征（MS）特有的代谢异常是青少年中的新流行病。MS不仅是心血管疾病的危险因素，也是慢性肾脏病（CKD）的危险因素。因此，有一些理由将MS视为儿科肾病学家面临的新挑战。首先，成人CKD的主要病因——高血压和糖尿病肾病，都具有与内脏肥胖和胰岛素抵抗相关的相同病理生理异常，且都起源于儿童期。其次，由于肥胖流行也影响CKD儿童，MS成为CKD进展的危险因素。第三，MS特有的代谢异常可能给CKD儿童的心血管发病和死亡带来额外风险。最后，尽管肾移植可逆转尿毒症异常，但它与暴露于MS特有的新代谢危险因素有关，并且已发现MS是肾移植后移植物丢失和心血管发病的危险因素。MS是饮食能量摄入与消耗失衡导致脂肪过度积累的结果。因此，预防和治疗MS的最佳方法是体育活动以及维持瘦体重与脂肪量之间的适当关系。
