Redon Josep, Lurbe Empar
Hypertension Clinic, Hospital Clinico of Valencia, University of Valencia and INCLIVA Research Institute, Valencia, Spain,
Curr Hypertens Rep. 2015 Jun;17(6):555. doi: 10.1007/s11906-015-0555-z.
Body mass index has been found to be the second most important contributor to relative risk for developing end state renal disease (ESRD), after proteinuria. The impact of obesity on the kidney includes a wide spectrum, from characteristic pathologic lesions to increment in urinary albumin excretion (UAE) and proteinuria/or decrease in glomerular filtration rate (GFR). The cause of renal disease associated to obesity is not well understood, but two relevant elements emerge. The first is the presence of obesity-related glomerulopathy, and the second is the fat deposit in the kidney with impact on renal haemodynamics and intrarenal regulation. The mechanisms linking obesity and renal damage are complex and include haemodynamic changes, inflammation, oxidative stress, apoptosis, and finally renal scarring. The protection of kidney damage needs to combine weight reduction with the proper control of the cardiometabolic risk factors associated, hypertension, metabolic syndrome, diabetes and dyslipidaemia. The search for specific treatments merits future research.
体重指数已被发现是导致终末期肾病（ESRD）相对风险的第二大重要因素，仅次于蛋白尿。肥胖对肾脏的影响范围广泛，从特征性病理病变到尿白蛋白排泄量（UAE）增加和蛋白尿/或肾小球滤过率（GFR）降低。与肥胖相关的肾病病因尚不完全清楚，但有两个相关因素显现出来。第一个是肥胖相关肾小球病的存在，第二个是肾脏中的脂肪沉积对肾血流动力学和肾内调节产生影响。将肥胖与肾损伤联系起来的机制很复杂，包括血流动力学变化、炎症、氧化应激、细胞凋亡，最终导致肾瘢痕形成。保护肾脏损伤需要将减轻体重与适当控制相关的心脏代谢危险因素（高血压、代谢综合征、糖尿病和血脂异常）相结合。寻找特定治疗方法值得未来研究。
