Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Curr Opin Pediatr. 2018 Apr;30(2):241-246. doi: 10.1097/MOP.0000000000000586.
To review recent advances in the epidemiology, pathophysiology, clinical features, and treatment of obesity-related kidney disease.
Studies have confirmed that obesity is associated with increased risk of developing chronic kidney disease (CKD). This risk extends to those who are metabolically healthy, indicating that obesity per se contributes to CKD independent of the metabolic syndrome. Recent developments in the pathophysiology of obesity-related kidney disease indicate that chronic inflammation and abnormal lipid metabolism contribute to kidney cell injury. Children with severe obesity have increased prevalence of early kidney abnormalities, including albuminuria, decreased kidney function, and elevated biomarkers of early kidney injury. For these patients, bariatric surgery has emerged as a treatment option to consider. Longitudinal studies in children and adults have demonstrated that in patients with obesity-related kidney disease, kidney function and albuminuria improve following bariatric surgery.
The injurious renal effects of obesity are present in childhood, although the natural history and clinical spectrum of obesity-related kidney disease in children are not known. In obese children with early kidney disease, identification of kidney injury, implementation of preventive strategies, and prompt treatment are essential to improving clinical outcomes.
肥胖相关肾脏疾病的流行病学、病理生理学、临床特征和治疗的最新进展。
研究证实肥胖与慢性肾脏病（CKD）风险增加相关。这种风险扩展到代谢健康的人群，表明肥胖本身与代谢综合征无关，也会导致 CKD。肥胖相关肾脏疾病病理生理学的最新进展表明，慢性炎症和异常脂质代谢导致肾脏细胞损伤。严重肥胖的儿童早期肾脏异常的发生率增加，包括蛋白尿、肾功能下降和早期肾损伤的生物标志物升高。对于这些患者，减重手术已成为一种治疗选择。儿童和成人的纵向研究表明，在肥胖相关肾脏疾病患者中，减重手术后肾功能和蛋白尿改善。
肥胖对肾脏的损害在儿童期就已经存在，尽管儿童肥胖相关肾脏疾病的自然史和临床谱尚不清楚。对于肥胖且患有早期肾脏疾病的儿童，识别肾脏损伤、实施预防策略以及及时治疗对于改善临床结局至关重要。
