Nephrology Department, Rabin Medical Center, Petach Tikva, Israel; Nephrology Research Laboratory, Felsenstein Medical Research Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Department of Nephrology and Hypertension, Tel Aviv Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Semin Nephrol. 2021 Jul;41(4):358-370. doi: 10.1016/j.semnephrol.2021.06.007.
Obesity-related glomerulopathy (ORG) and other obesity-associated kidney diseases pose a major challenge to the treating nephrologist. We review the benefits of weight loss and optimal management of ORG and kidney disease in the setting of obesity. Therapeutic strategies in ORG were limited mainly in the past to weight loss through lifestyle interventions and bariatric surgery, antihypertensive treatment, and renin-angiotensin-aldosterone system blockade. Current approaches to obtain the desired weight loss include novel pharmacologic therapies that have been approved for the treatment of diabetes while offering kidney protection, such as sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1-receptor agonists. This review focuses on the nephroprotective role of the renin-angiotensin-aldosterone system blockade and of these new pharmacologic agents, and on the renal effects of bariatric surgery in chronic kidney disease.
肥胖相关性肾小球病（ORG）和其他与肥胖相关的肾脏疾病给治疗肾病的医生带来了巨大挑战。我们综述了肥胖背景下减轻体重和优化 ORG 及肾脏疾病管理的获益。过去，ORG 的治疗策略主要限于通过生活方式干预和减重手术、降压治疗以及肾素-血管紧张素-醛固酮系统阻断来减轻体重。目前获得理想体重的方法包括已被批准用于治疗糖尿病的新型药物治疗，这些药物在提供肾脏保护的同时还具有降糖作用，如钠-葡萄糖共转运蛋白 2 抑制剂和胰高血糖素样肽-1 受体激动剂。本文重点讨论了肾素-血管紧张素-醛固酮系统阻断以及这些新型药物的肾脏保护作用，还讨论了减重手术对慢性肾脏病的肾脏影响。
