Department of Nephrology, Tokyo Women's Medical University, Tokyo, Japan.
Front Endocrinol (Lausanne). 2023 Feb 9;14:1097596. doi: 10.3389/fendo.2023.1097596. eCollection 2023.
Visceral adipose tissue plays a central role in obesity and metabolic syndrome and is an independent risk factor for both cardiovascular and metabolic disorders. Increased visceral adipose tissue promotes adipokine dysregulation and insulin resistance, leading to several health issues, including systemic inflammation, oxidative stress, and activation of the renin-angiotensin-aldosterone system. Moreover, an increase in adipose tissue directly and indirectly affects the kidneys by increasing renal sodium reabsorption, causing glomerular hyperfiltration and hypertrophy, which leads to increased proteinuria and kidney fibrosis/dysfunction. Although the interest in the adverse effects of obesity on renal diseases has grown exponentially in recent years, the relationship between obesity and renal prognosis remains controversial. This may be attributed to the long clinical course of obesity, numerous obesity-related metabolic complications, and patients' attributes. Multiple individual attributes influencing the pathophysiology of fat accumulation make it difficult to understand obesity. In such cases, it may be effective to elucidate the pathophysiology by conducting research tailored to individual attributes from the perspective of attribute-based medicine/personalized medicine. We consider the appropriate use of clinical indicators necessary, according to attributes such as chronic kidney disease stage, level of visceral adipose tissue accumulation, age, and sex. Selecting treatments and clinical indicators based on individual attributes will allow for advancements in the clinical management of patients with obesity and chronic kidney disease. In the clinical setting of obesity-related nephropathy, it is first necessary to accumulate attribute-based studies resulting from the accurate evaluation of visceral fat accumulation to establish evidence for promoting personalized medicine.
内脏脂肪组织在肥胖和代谢综合征中起着核心作用,是心血管和代谢紊乱的独立危险因素。内脏脂肪组织的增加会促进脂肪因子失调和胰岛素抵抗,导致多种健康问题,包括全身炎症、氧化应激和肾素-血管紧张素-醛固酮系统的激活。此外,脂肪组织的增加通过增加肾脏对钠的重吸收,直接和间接地影响肾脏,导致肾小球高滤过和肥大,从而导致蛋白尿和肾脏纤维化/功能障碍增加。
尽管近年来人们对肥胖对肾脏疾病的不良影响的兴趣呈指数级增长,但肥胖与肾脏预后之间的关系仍存在争议。这可能归因于肥胖的临床病程长、与肥胖相关的代谢并发症众多以及患者的属性。影响脂肪堆积病理生理学的多个个体属性使得理解肥胖变得困难。在这种情况下,从基于属性的医学/个性化医学的角度出发,针对个体属性进行量身定制的研究,可能有助于阐明其病理生理学。我们认为,根据慢性肾脏病分期、内脏脂肪堆积程度、年龄和性别等属性,适当使用临床指标是必要的。根据个体属性选择治疗方法和临床指标将有助于推进肥胖和慢性肾脏病患者的临床管理。
在肥胖相关性肾病的临床环境中,首先需要积累基于属性的研究,这些研究是基于对内脏脂肪堆积的准确评估得出的,以建立促进个性化医学的证据。
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