Wang Ting-Yao, Wang Rui-Fang, Bu Zhi-Ying, Targher Giovanni, Byrne Christopher D, Sun Dan-Qin, Zheng Ming-Hua
Department of Nephrology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Department of Nephrology, the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, Wuxi, China.
Nat Rev Nephrol. 2022 Apr;18(4):259-268. doi: 10.1038/s41581-021-00519-y. Epub 2022 Jan 10.
Non-alcoholic fatty liver disease (NAFLD) is characterized by the accumulation of fat in more than 5% of hepatocytes in the absence of excessive alcohol consumption and other secondary causes of hepatic steatosis. In 2020, the more inclusive term metabolic (dysfunction)-associated fatty liver disease (MAFLD) - defined by broader diagnostic criteria - was proposed to replace the term NAFLD. The new terminology and revised definition better emphasize the pathogenic role of metabolic dysfunction and uses a set of definitive, inclusive criteria for diagnosis. Diagnosis of MAFLD is based on evidence of hepatic steatosis (as assessed by liver biopsy, imaging techniques or blood biomarkers and scores) in persons who are overweight or obese and have type 2 diabetes mellitus or metabolic dysregulation, regardless of the coexistence of other liver diseases or excessive alcohol consumption. The known association between NAFLD and chronic kidney disease (CKD) and our understanding that CKD can occur as a consequence of metabolic dysfunction suggests that individuals with MAFLD - who by definition have fatty liver and metabolic comorbidities - are at increased risk of CKD. In this Perspective article, we discuss the clinical associations between MAFLD and CKD, the pathophysiological mechanisms by which MAFLD may increase the risk of CKD and the potential drug treatments that may benefit both conditions.
非酒精性脂肪性肝病（NAFLD）的特征是在无过量饮酒及其他继发性肝脂肪变性病因的情况下，超过5%的肝细胞出现脂肪堆积。2020年，有人提出用更具包容性的术语代谢（功能障碍）相关脂肪性肝病（MAFLD）——由更宽泛的诊断标准定义——来取代NAFLD这一术语。新的术语和修订后的定义更好地强调了代谢功能障碍的致病作用，并采用了一套明确、全面的诊断标准。MAFLD的诊断基于超重或肥胖且患有2型糖尿病或代谢失调者存在肝脂肪变性的证据（通过肝活检、成像技术或血液生物标志物及评分评估），无论是否并存其他肝脏疾病或过量饮酒。NAFLD与慢性肾脏病（CKD）之间的已知关联，以及我们对CKD可作为代谢功能障碍后果而发生的认识，提示患有MAFLD的个体——根据定义其患有脂肪肝和代谢合并症——患CKD的风险增加。在这篇观点文章中，我们讨论了MAFLD与CKD之间的临床关联、MAFLD可能增加CKD风险的病理生理机制以及可能对这两种疾病都有益的潜在药物治疗方法。
