Oliveras Anna, Vázquez Susana, Soler María José, Galceran Isabel, Duran Xavier, Goday Albert, Benaiges David, Crespo Marta, Pascual Julio, Riera Marta
Nephrology Department, Hospital Universitari del Mar, 08003 Barcelona, Spain.
IMIM, Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain.
J Clin Med. 2022 Jan 29;11(3):728. doi: 10.3390/jcm11030728.
Obesity-related hyperfiltration leads to an increased glomerular filtration rate (GFR) and hyperalbuminuria. These changes are reversible after bariatric surgery (BS). We aimed to explore obesity-related renal changes post-BS and to seek potential mechanisms. Sixty-two individuals with severe obesity were prospectively examined before and 3, 6 and 12 months post-BS. Anthropometric and laboratory data, 24 h-blood pressure, renin-angiotensin-aldosterone system (RAS) components, adipokines and inflammatory markers were determined. Both estimated GFR (eGFR) and albuminuria decreased from the baseline at all follow-up times (-for-trend <0.001 for both). There was a median (IQR) of 30.5% (26.2-34.4) reduction in body weight. Plasma glucose, glycosylated hemoglobin, fasting insulin and HOMA-index decreased at 3, 6 and 12 months of follow-up (-for-trend <0.001 for all). The plasma aldosterone concentration (median (IQR)) also decreased at 12 months (from 87.8 ng/dL (56.8; 154) to 65.4 (56.8; 84.6), = 0.003). Both leptin and hs-CRP decreased ( < 0.001) and adiponectine levels increased at 12 months post-BS ( = 0.017). Linear mixed-models showed that body weight (coef. 0.62, 95% CI: 0.32 to 0.93, < 0.001) and plasma aldosterone (coef. -0.07, 95% CI: -0.13 to -0.02, = 0.005) were the independent variables for changes in eGFR. Conversely, glycosylated hemoglobin was the only independent variable for changes in albuminuria (coef. 0.24, 95% CI: 0.06 to 0.42, = 0.009). In conclusion, body weight and aldosterone are the main factors that mediate eGFR changes in obesity and BS, while albuminuria is associated with glucose homeostasis.
肥胖相关的高滤过会导致肾小球滤过率（GFR）增加和微量白蛋白尿。这些变化在减肥手术后（BS）是可逆的。我们旨在探讨减肥手术后与肥胖相关的肾脏变化，并寻找潜在机制。对62例严重肥胖个体在减肥手术前以及术后3、6和12个月进行前瞻性检查。测定人体测量和实验室数据、24小时血压、肾素-血管紧张素-醛固酮系统（RAS）成分、脂肪因子和炎症标志物。在所有随访时间，估计肾小球滤过率（eGFR）和白蛋白尿均较基线水平下降（两者的趋势P值均<0.001）。体重中位数（四分位间距）下降了30.5%（26.2-34.4）。随访3、6和12个月时，血浆葡萄糖、糖化血红蛋白、空腹胰岛素和HOMA指数均下降（所有趋势P值均<0.001）。血浆醛固酮浓度（中位数（四分位间距））在12个月时也下降（从87.8 ng/dL（56.8；154）降至65.4（56.8；84.6），P=0.003）。减肥手术后12个月，瘦素和hs-CRP均下降（P<0.001），脂联素水平升高（P=0.017）。线性混合模型显示，体重（系数0.62，95%置信区间：0.32至0.93，P<0.001）和血浆醛固酮（系数-0.07，95%置信区间：-0.13至-0.02，P=0.005）是eGFR变化的独立变量。相反，糖化血红蛋白是白蛋白尿变化的唯一独立变量（系数0.24，95%置信区间：0.06至0.42，P=0.009）。总之，体重和醛固酮是肥胖和减肥手术中eGFR变化的主要介导因素，而白蛋白尿与葡萄糖稳态相关。
