Rosenstock Jordan L, Pommier Max, Stoffels Guillaume, Patel Satyam, Michelis Michael F
Division of Nephrology, Lenox Hill Hospital, Northwell Health, New York, NY, United States.
Division of Biostatistics, Lenox Hill Hospital, Northwell Health, New York, NY, United States.
Front Med (Lausanne). 2018 Apr 30;5:122. doi: 10.3389/fmed.2018.00122. eCollection 2018.
Obesity has been increasingly recognized as a risk factor for kidney disease and both proteinuria and microalbuminuria have been associated with obesity. The actual prevalence of microalbuminuria and proteinuria in obese patients in the United States (US) has not been clearly described in the literature. Furthermore, obesity is associated with risk factors of kidney disease, such as diabetes and hypertension (HTN), and the prevalence of proteinuria and albuminuria excluding these risk factors is uncertain. In this study, we collected urine albumin/creatinine and urine protein/creatinine ratios on obese patients undergoing bariatric surgery to determine the prevalence of albuminuria and proteinuria in obese patients with and without associated diabetes and HTN. The study included 218 obese patients undergoing bariatric surgery at a New York City hospital. The mean age was 42.1 ± 11.3 years. The mean body mass index (BMI) was 43.9 ± 8.1. Diabetes (DM) was present in 25%. HTN was present in 47%. The prevalence of proteinuria and albuminuria was 21% (95% CI: 15.8-27.1%) and 19.7% (95% CI: 14.2-26.2%) respectively. Among those without DM but who had HTN, 22.6% (95% CI: 12.9-35) had proteinuria and 17% (95% CI 8.4-30.9) had albuminuria. Of patients with neither DM nor HTN, 13.3% (95% CI: 7.3-21.6) and 11% (95% CI: 5-17%) had proteinuria and albuminuria, respectively. Diabetics had a significantly higher prevalence of proteinuria and albuminuria than the non-diabetic groups. The non-diabetic groups did not differ significantly from each other in terms of prevalence of proteinuria and albuminuria. The BMI for diabetics did not differ from non-diabetics. On multivariate analysis, only the presence of diabetes was associated with proteinuria and albuminuria. BMI, age, and HTN were not predictive. In conclusion, we found a relatively high prevalence of microalbuminuria and proteinuria in an urban, US, obese population undergoing bariatric surgery. When diabetics were excluded, there was a lower prevalence. Even patients who had neither diabetes nor HTN, still, however, had much greater amounts than seen in the general US population, likely reflecting an adverse effect of obesity itself on renal physiology.
肥胖已越来越被视为肾病的一个风险因素，蛋白尿和微量白蛋白尿均与肥胖相关。美国肥胖患者中微量白蛋白尿和蛋白尿的实际患病率在文献中尚未得到明确描述。此外，肥胖与肾病的风险因素如糖尿病和高血压相关，排除这些风险因素后的蛋白尿和白蛋白尿患病率尚不确定。在本研究中，我们收集了接受减肥手术的肥胖患者的尿白蛋白/肌酐和尿蛋白/肌酐比值，以确定伴有和不伴有相关糖尿病及高血压的肥胖患者中白蛋白尿和蛋白尿的患病率。该研究纳入了纽约市一家医院218例接受减肥手术的肥胖患者。平均年龄为42.1±11.3岁。平均体重指数（BMI）为43.9±8.1。25%的患者患有糖尿病（DM）。47%的患者患有高血压（HTN）。蛋白尿和白蛋白尿的患病率分别为21%（95%CI：15.8 - 27.1%）和19.7%（95%CI：14.2 - 26.2%）。在无糖尿病但患有高血压的患者中，22.6%（95%CI：12.9 - 35）有蛋白尿，17%（95%CI 8.4 - 30.9）有白蛋白尿。在既无糖尿病也无高血压的患者中，分别有13.3%（95%CI：7.3 - 21.6）和11%（95%CI：5 - 17%）有蛋白尿和白蛋白尿。糖尿病患者的蛋白尿和白蛋白尿患病率显著高于非糖尿病组。非糖尿病组在蛋白尿和白蛋白尿患病率方面彼此无显著差异。糖尿病患者的BMI与非糖尿病患者无差异。多因素分析显示，只有糖尿病的存在与蛋白尿和白蛋白尿相关。BMI、年龄和高血压无预测作用。总之，我们发现美国城市中接受减肥手术的肥胖人群中微量白蛋白尿和蛋白尿的患病率相对较高。排除糖尿病患者后，患病率较低。然而，即使是既无糖尿病也无高血压的患者，其患病率仍远高于美国普通人群，这可能反映了肥胖本身对肾脏生理的不良影响。
