Chade Alejandro R, Hall John E
Department of Physiology and Biophysics, Center for Excellence in Cardiovascular-Renal Research, University of Mississippi Medical Center, Jackson, Miss., USA.
Am J Nephrol. 2016;44(5):354-367. doi: 10.1159/000452365. Epub 2016 Oct 22.
Obesity is largely responsible for the growing incidence and prevalence of diabetes, cardiovascular and renal diseases. Current strategies to prevent and treat obesity and its consequences have been insufficient to reverse the ongoing trends. Lifestyle modification or pharmacological therapies often produce modest weight loss which is not sustained and recurrence of obesity is frequently observed, leading to progression of target organ damage in many obese subjects. Therefore, research efforts have focused not only on the factors that regulate energy balance, but also on understanding mechanisms of target organ injury in obesity. Summary and Key Message: Microvascular (MV) disease plays a pivotal role in progressive kidney injury from different etiologies such as hypertension, diabetes, and atherosclerosis, which are all important consequences of chronic obesity. The MV networks are anatomical units that are closely adapted to specific functions of nutrition and removal of waste in every organ. Damage of the small vessels in several tissues and organs has been reported in obesity and may increase cardio-renal risk. However, the mechanisms by which obesity and its attendant cardiovascular and metabolic consequences interact to cause renal MV injury and chronic kidney disease are still unclear, although substantial progress has been made in recent years. This review addresses potential mechanisms and consequences of obesity-induced renal MV injury as well as current treatments that may provide protection of the renal microcirculation and slow progressive kidney injury in obesity.
肥胖在很大程度上导致了糖尿病、心血管疾病和肾脏疾病发病率及患病率的不断上升。目前预防和治疗肥胖及其后果的策略尚不足以扭转当前的趋势。生活方式改变或药物治疗往往只能带来适度的体重减轻，且难以维持，肥胖复发屡见不鲜，导致许多肥胖患者的靶器官损伤不断进展。因此，研究工作不仅聚焦于调节能量平衡的因素，还致力于了解肥胖状态下靶器官损伤的机制。总结与关键信息：微血管（MV）疾病在由高血压、糖尿病和动脉粥样硬化等不同病因导致的进行性肾损伤中起关键作用，而这些病因都是慢性肥胖的重要后果。微血管网络是紧密适应各器官营养供应和废物清除特定功能的解剖单位。肥胖状态下已报道多个组织和器官的小血管受损，这可能增加心肾风险。然而，尽管近年来取得了显著进展，但肥胖及其相关心血管和代谢后果相互作用导致肾微血管损伤和慢性肾病的机制仍不清楚。本综述探讨了肥胖诱导的肾微血管损伤的潜在机制和后果，以及目前可能为肥胖患者的肾微循环提供保护并延缓进行性肾损伤的治疗方法。
