3rd Department of Internal Medicine, Hypertension-24h ABPM ESH Center of Excellence, Papageorgiou Hospital, Aristotle University of Thessaloniki, 564 29 Pavlos Melas, Greece.
Internal Medicine Hospital Clínico de Valencia, 46010 Valencia, Spain.
Nutrients. 2021 Dec 15;13(12):4482. doi: 10.3390/nu13124482.
The clinical consequences of obesity on the kidneys, with or without metabolic abnormalities, involve both renal function and structures. The mechanisms linking obesity and renal damage are well understood, including several effector mechanisms with interconnected pathways. Higher prevalence of urinary albumin excretion, sub-nephrotic syndrome, nephrolithiasis, increased risk of developing CKD, and progression to ESKD have been identified as being associated with obesity and having a relevant clinical impact. Moreover, renal replacement therapy and kidney transplantation are also influenced by obesity. Losing weight is key in limiting the impact that obesity produces on the kidneys by reducing albuminuria/proteinuria, declining rate of eGFR deterioration, delaying the development of CKD and ESKD, and improving the outcome of a renal transplant. Weight reduction may also contribute to appropriate control of cardiometabolic risk factors such as hypertension, metabolic syndrome, diabetes, and dyslipidemia which may be protective not only in renal damage but also cardiovascular disease. Lifestyle changes, some drugs, and bariatric surgery have demonstrated the benefits.
肥胖对肾脏的临床影响，无论是否伴有代谢异常，均涉及肾功能和结构。肥胖与肾损伤相关的机制已被充分阐明，包括几个具有相互关联途径的效应机制。肥胖与尿白蛋白排泄增加、亚肾病综合征、肾结石、CKD 风险增加和进展为 ESKD 相关，并具有相关的临床影响。此外，肥胖还会影响肾脏替代治疗和肾移植。减轻体重是通过减少蛋白尿/蛋白尿、降低 eGFR 恶化速度、延缓 CKD 和 ESKD 的发展以及改善肾移植结果来限制肥胖对肾脏产生影响的关键。体重减轻还可能有助于适当控制高血压、代谢综合征、糖尿病和血脂异常等心血管代谢危险因素，这些危险因素不仅对肾脏损伤而且对心血管疾病都具有保护作用。生活方式改变、一些药物和减肥手术已经证明了其益处。
