Department of Internal Medicine, Goesan Sungmo Hospital, Goesan, Korea.
Division of Nephrology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2024 Jan 22;39(3):e12. doi: 10.3346/jkms.2024.39.e12.
The obesity epidemic is associated with the emergence of new kidney diseases including obesity-related glomerulopathy (ORG) and metabolic syndrome-associated disorders. However, the effects of obesity on prevalence and outcome of biopsy-proven kidney disease are not well known.
We analyzed 14,492 kidney biopsies in 18 hospitals from 1979 to 2018 in Korea. Obesity was defined as a body mass index value of ≥ 30 kg/m².
The most common disease was IgA nephropathy (IgAN) in both obese and non-obese participants (33.7% vs. 38.9%). Obesity was associated with a higher risk of focal segmental glomerulosclerosis (FSGS) and hypertensive nephropathy (HT-N) (odds ratio [OR], 1.72, 95% confidence interval [CI], 1.37-2.17; OR, 1.96, 95% CI, 1.21-3.19) and a lower risk of IgAN (OR, 0.74, 95% CI, 0.62-0.88). During the median follow up of 93.1 ± 88.7 months, obesity increased the risk of end-stage kidney disease (ESKD) in patients with IgAN (relative risk [RR], 1.49, 95% CI, 1.01-2.20) and lupus nephritis (LN) (RR, 3.43, 95% CI, 1.36-8.67). Of 947 obese individuals, ORG was detected in 298 (31.5%), and 230 participants had other kidney diseases, most commonly, IgAN (40.9%) followed by diabetic nephropathy (15.2%). Participants with ORG, when combined with other renal diseases, showed higher risks for developing ESKD compared to those with ORG alone (RR, 2.48, 95% CI, 1.09-5.64).
Obesity is associated with an increased risk of FSGS and HT-N, and also increase the ESKD risk in IgAN and LN patients. ORG in obese participants may have favorable renal outcomes if it occurs alone without any other renal disease.
肥胖症的流行与新的肾脏疾病的出现有关，包括肥胖相关性肾小球病（ORG）和代谢综合征相关疾病。然而，肥胖对活检证实的肾脏疾病的患病率和结局的影响尚不清楚。
我们分析了 1979 年至 2018 年韩国 18 家医院的 14492 例肾脏活检。肥胖定义为体重指数（BMI）值≥30kg/m²。
在肥胖和非肥胖参与者中，最常见的疾病均为 IgA 肾病（IgAN）（33.7% vs. 38.9%）。肥胖与局灶节段性肾小球硬化症（FSGS）和高血压性肾病（HT-N）的风险增加相关（优势比[OR]，1.72，95%置信区间[CI]，1.37-2.17；OR，1.96，95%CI，1.21-3.19），而与 IgAN 的风险降低相关（OR，0.74，95%CI，0.62-0.88）。在中位随访 93.1±88.7 个月期间，肥胖增加了 IgAN（相对风险[RR]，1.49，95%CI，1.01-2.20）和狼疮性肾炎（LN）（RR，3.43，95%CI，1.36-8.67）患者发生终末期肾病（ESKD）的风险。在 947 名肥胖者中，发现 298 名（31.5%）患有 ORG，230 名参与者患有其他肾脏疾病，最常见的是 IgAN（40.9%），其次是糖尿病肾病（15.2%）。与仅患有 ORG 的参与者相比，同时患有 ORG 和其他肾脏疾病的参与者发生 ESKD 的风险更高（RR，2.48，95%CI，1.09-5.64）。
肥胖与 FSGS 和 HT-N 的风险增加有关，并且还会增加 IgAN 和 LN 患者的 ESKD 风险。如果肥胖患者仅患有 ORG 而无其他任何肾脏疾病，则其肾脏结局可能较好。
