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Ekperikpe US, Poudel B, Shields CA, Mandal S, Cornelius DC, Williams JM. Neutralizing MIP3 α Reduces Renal Immune Cell Infiltration and Progressive Renal Injury in Young Obese Dahl Salt-Sensitive Rats. J Pharmacol Exp Ther 2023; 384:445-454. [PMID: 36507846 PMCID: PMC9976792 DOI: 10.1124/jpet.122.001298] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
Recently, we reported that the early progression of renal injury in obese Dahl salt-sensitive leptin receptor mutant (SSLepRmutant) rats was associated with increased macrophage inflammatory protein 3-α (MIP3α) expression prior to puberty. Therefore, this study tested the hypothesis that MIP3α plays a role in recruiting immune cells, thereby triggering renal inflammation and early progressive renal injury in SSLepRmutant rats prior to puberty. Four-week-old Dahl salt-sensitive (SS) and SSLepRmutant rats either served as control (IgG; intraperitoneal, every other day) or received MIP3α-neutralizing antibody (MNA; 100 µg/kg) for 4 weeks. MNA reduced circulating and renal MIP3α levels and proinflammatory immune cells by 50%. Although MNA treatment did not affect blood glucose and plasma cholesterol levels, MNA markedly decreased insulin resistance and triglyceride levels in SSLepRmutant rats. We observed no differences in mean arterial pressure (MAP) between SS and SSLepRmutant rats, and MNA had no effect on MAP in either strain. Proteinuria was significantly increased in SSLepRmutant rats versus SS rats over the course of the study. Treatment with MNA markedly decreased proteinuria in SSLepRmutant rats while not affecting SS rats. Also, MNA decreased glomerular and tubular injury and renal fibrosis in SSLepRmutant rats while not affecting SS rats. Overall, these data indicate that MIP3α plays an important role in renal inflammation during the early progression of renal injury in obese SSLepRmutant rats prior to puberty. These data also suggest that MIP3α may be a novel therapeutic target to inhibit insulin resistance and prevent progressive proteinuria in obese children. SIGNIFICANCE STATEMENT: Childhood obesity is increasing at an alarming rate and is now being associated with renal disease. Although most studies have focused on the mechanisms of renal injury associated with adult obesity, few studies have examined the mechanisms of renal injury involved during childhood obesity. In the current study, we observed that the progression of renal injury in obese Dahl salt-sensitive leptin receptor mutant rats was associated with an increase in MIP3α, a chemokine, before puberty, and inhibition of MIP3α markedly reduced renal injury.
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Affiliation(s)
- Ubong S Ekperikpe
- Departments of Pharmacology and Toxicology and Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Bibek Poudel
- Departments of Pharmacology and Toxicology and Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Corbin A Shields
- Departments of Pharmacology and Toxicology and Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Sautan Mandal
- Departments of Pharmacology and Toxicology and Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Denise C Cornelius
- Departments of Pharmacology and Toxicology and Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Jan M Williams
- Departments of Pharmacology and Toxicology and Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi
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Adeva-Andany MM, Adeva-Contreras L, Fernández-Fernández C, Carneiro-Freire N, Domínguez-Montero A. Histological Manifestations of Diabetic Kidney Disease and its Relationship with Insulin Resistance. Curr Diabetes Rev 2023; 19:50-70. [PMID: 35346008 DOI: 10.2174/1573399818666220328145046] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/18/2022] [Accepted: 02/08/2022] [Indexed: 11/22/2022]
Abstract
Histological manifestations of diabetic kidney disease (DKD) include mesangiolysis, mesangial matrix expansion, mesangial cell proliferation, thickening of the glomerular basement membrane, podocyte loss, foot process effacement, and hyalinosis of the glomerular arterioles, interstitial fibrosis, and tubular atrophy. Glomerulomegaly is a typical finding. Histological features of DKD may occur in the absence of clinical manifestations, having been documented in patients with normal urinary albumin excretion and normal glomerular filtration rate. Furthermore, the histological picture progresses over time, while clinical data may remain normal. Conversely, histological lesions of DKD improve with metabolic normalization following effective pancreas transplantation. Insulin resistance has been associated with the clinical manifestations of DKD (nephromegaly, glomerular hyperfiltration, albuminuria, and kidney failure). Likewise, insulin resistance may underlie the histological manifestations of DKD. Morphological changes of DKD are absent in newly diagnosed type 1 diabetes patients (with no insulin resistance) but appear afterward when insulin resistance develops. In contrast, structural lesions of DKD are typically present before the clinical diagnosis of type 2 diabetes. Several heterogeneous conditions that share the occurrence of insulin resistance, such as aging, obesity, acromegaly, lipodystrophy, cystic fibrosis, insulin receptor dysfunction, and Alström syndrome, also share both clinical and structural manifestations of kidney disease, including glomerulomegaly and other features of DKD, focal segmental glomerulosclerosis, and C3 glomerulopathy, which might be ascribed to the reduction in the synthesis of factor H binding sites (such as heparan sulfate) that leads to uncontrolled complement activation. Alström syndrome patients show systemic interstitial fibrosis markedly similar to that present in diabetes.
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Affiliation(s)
- María M Adeva-Andany
- Internal Medicine Department, Nephrology Division, Hospital General Juan Cardona c/ Pardo Bazán s/n, 15406 Ferrol, Spain
| | - Lucía Adeva-Contreras
- University of Santiago de Compostela Medical School, Santiago de Compostela, Acoruna, Spain
| | - Carlos Fernández-Fernández
- Internal Medicine Department, Nephrology Division, Hospital General Juan Cardona c/ Pardo Bazán s/n, 15406 Ferrol, Spain
| | - Natalia Carneiro-Freire
- Internal Medicine Department, Nephrology Division, Hospital General Juan Cardona c/ Pardo Bazán s/n, 15406 Ferrol, Spain
| | - Alberto Domínguez-Montero
- Internal Medicine Department, Nephrology Division, Hospital General Juan Cardona c/ Pardo Bazán s/n, 15406 Ferrol, Spain
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Moriconi D, Nannipieri M, Dadson P, Rosada J, Tentolouris N, Rebelos E. The Beneficial Effects of Bariatric-Surgery-Induced Weight Loss on Renal Function. Metabolites 2022; 12:967. [PMID: 36295869 PMCID: PMC9608617 DOI: 10.3390/metabo12100967] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/08/2022] [Accepted: 10/08/2022] [Indexed: 08/05/2023] Open
Abstract
Obesity represents an independent risk factor for the development of chronic kidney disease (CKD), leading to specific histopathological alterations, known as obesity-related glomerulopathy. Bariatric surgery is the most effective means of inducing and maintaining sustained weight loss. Furthermore, in the context of bariatric-surgery-induced weight loss, a reduction in the proinflammatory state and an improvement in the adipokine profile occur, which may also contribute to the improvement of renal function following bariatric surgery. However, the assessment of renal function in the context of obesity and following marked weight loss is difficult, since the formulas adopted to estimate glomerular function use biomarkers whose production is dependent on muscle mass (creatinine) or adipose tissue mass and inflammation (cystatin-c). Thus, following bariatric surgery, the extent to which reductions in plasma concentrations reflect the actual improvement in renal function is not clear. Despite this limitation, the available literature suggests that in patients with hyperfiltration at baseline, GFR is reduced following bariatric surgery, whereas GFR is increased in patients with decreased GFR at baseline. These findings are also confirmed in the few studies that have used measured rather than estimated GFR. Albuminuria is also decreased following bariatric surgery. Moreover, bariatric surgery seems superior in achieving the remission of albuminuria and early CKD than the best medical treatment. In this article, we discuss the pathophysiology of renal complications in obesity, review the mechanisms through which weight loss induces improvements in renal function, and provide an overview of the renal outcomes following bariatric surgery.
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Affiliation(s)
- Diego Moriconi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Monica Nannipieri
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Prince Dadson
- Turku PET Centre, University of Turku, 20500 Turku, Finland
| | - Javier Rosada
- Fourth Unit of Internal Medicine, University Hospital of Pisa, 56124 Pisa, Italy
| | - Nikolaos Tentolouris
- Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
| | - Eleni Rebelos
- Turku PET Centre, University of Turku, 20500 Turku, Finland
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy
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Abstract
The kidney is one of the target organs that may show health disorders as a result of obesity. Obesity-related glomerulopathy (ORG) is a kidney disease category based on a biopsy diagnosis that may occur secondary to obesity. Detailed clinicopathologic observations of ORG have provided significant knowledge regarding obesity-associated renal complications. Glomerulomegaly with focal segmental glomerulosclerosis of perihilar locations is a typical renal histopathologic finding in ORG, which has long been considered to represent a state of single-nephron glomerular hyperfiltration. This hypothesis was recently confirmed in ORG patients by estimating single-nephron glomerular filtration rate using a combined image analysis and biopsy-based stereology. Overshooting in glomerulotubular and tubuloglomerular interactions may lead to glomerular hyperfiltration/hypertension, podocyte failure, tubular protein-traffic overload, and tubulointerstitial scarring, constituting a vicious cycle of a common pathway to the further loss of functioning nephrons and the progression of kidney functional impairment.
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Affiliation(s)
- Nobuo Tsuboi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
| | - Yusuke Okabayashi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Kurt-Bayrakdar S, Kose O, Altin A, Akyildiz K, Mercantepe T, Bostan SA, Kose TE, Tumkaya L, Yilmaz A. Periodontitis exacerbates the renal degenerative effects of obesity in rats. J Periodontal Res 2021; 56:1058-1069. [PMID: 34328646 DOI: 10.1111/jre.12919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 06/21/2021] [Accepted: 07/20/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVES Obesity and periodontitis are systemic subclinical inflammatory diseases with established negative renal effects. The aim of this animal study was to thoroughly investigate the possible effects of these two diseases on renal structure and function. METHODS Thirty-two male Sprague Dawley rats were divided into four groups: control (C), obesity (Ob), experimental periodontitis (Ep), and Ob + Ep. The first 16 weeks of the experiment were aimed for the induction of obesity and the last 5 weeks for the induction of periodontitis. Throughout the experimental period, the C and Ep groups were fed standard rat chow, while the Ob groups (Ob and Ob + Ep) were fed high-fat rat chow. Right after the establishment of obesity, periodontal tissue destruction was achieved by placing 3.0 silk sutures in sub-paramarginal position around the cervices of mandibular right-left first molar teeth and preserving them for 5 weeks. On the last day of the 22nd week, following blood collection, all rats were euthanized, and kidneys and mandibles were collected. Alveolar bone loss was measured on microcomputed tomographic slices. Histopathological evaluations (light microscopy, semi-quantitative analysis of renal corpuscle area, and immunohistochemical analysis of caspase-3 activity) were done on right kidneys and biochemical evaluations (malonyl-aldehyde [MDA], glutathione [GSH], total oxidant status [TOS], total antioxidant status [TAS], oxidative stress [OSI], tumor necrosis factor-α [TNF-α], interleukin-1β [IL-1β], matrix metalloproteinase [MMP]-8, MMP-9, and cathepsin D [CtD] levels) were done on left kidneys. Renal functional status was evaluated with levels of serum creatinine, urea, and cystatin C. RESULTS Periodontal bone loss was significantly higher in the Ep and Ob + Ep groups, compared with the C and Ob groups (p < .05). All parameters except TAS and GSH were highest in the Ob + Ep group, and the differences were statistically significant compared with the control group (p < .05). Although the mean TAS and GSH levels were lower in the Ob + Ep group than the other groups, the differences were not statistically significant (p > .05). While the atypical glomeruli score was significantly higher in the Ob + Ep group than in all other groups (p < .05), the acute tubular necrosis and histopathological scores were significantly different only compared with the control group (p < .05). CONCLUSION This experimental study showed that the negative effects of the co-existence of periodontitis and obesity on inflammatory stress and apoptotic changes in the kidneys together with the functional parameters were significantly more severe, compared with the presence of one of these diseases alone. TNF-α could have a central role in the periodontitis and obesity-related structural and functional renal changes.
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Affiliation(s)
- Sevda Kurt-Bayrakdar
- Department of Periodontology, School of Dentistry, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Oğuz Kose
- Department of Periodontology, School of Dentistry, Recep Tayyip Erdogan University, Rize, Turkey
| | - Ahmet Altin
- Department of Periodontology, School of Dentistry, Recep Tayyip Erdogan University, Rize, Turkey
| | - Kerimali Akyildiz
- Department of Medical Services and Techniques, School of Health Care Services Vocational, Recep Tayyip Erdogan University, Rize, Turkey
| | - Tolga Mercantepe
- Department of Histology and Embryology, School of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Semih Alperen Bostan
- Department of Periodontology, School of Dentistry, Recep Tayyip Erdogan University, Rize, Turkey
| | - Taha Emre Kose
- Department of Dentomaxillofacial Radiology, School of Dentistry, Recep Tayyip Erdogan University, Rize, Turkey
| | - Levent Tumkaya
- Department of Histology and Embryology, School of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Adnan Yilmaz
- Department of Biochemistry, School of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
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Kramer H, Kalantar-Zadeh K. Obesity, preterm birth and kidney disease: a global epidemic. Nephrol Dial Transplant 2019; 34:1653-1656. [PMID: 31579925 DOI: 10.1093/ndt/gfy383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 11/14/2018] [Indexed: 01/22/2023] Open
Affiliation(s)
- Holly Kramer
- Department of Public Health Sciences and Medicine, Division of Nephrology and Hypertension, Loyola University Chicago, Maywood, IL, USA
| | - Kam Kalantar-Zadeh
- Department of Medicine, Division of Nephrology, University of California Irvine, Orange, CA, USA
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Yan Y, Wang J, Chaudhry MA, Nie Y, Sun S, Carmon J, Shah PT, Bai F, Pratt R, Brickman C, Sodhi K, Kim JH, Pierre S, Malhotra D, Rankin GO, Xie ZJ, Shapiro JI, Liu J. Metabolic Syndrome and Salt-Sensitive Hypertension in Polygenic Obese TALLYHO/JngJ Mice: Role of Na/K-ATPase Signaling. Int J Mol Sci 2019; 20:ijms20143495. [PMID: 31315267 PMCID: PMC6678942 DOI: 10.3390/ijms20143495] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/06/2019] [Accepted: 07/13/2019] [Indexed: 12/12/2022] Open
Abstract
We have demonstrated that Na/K-ATPase acts as a receptor for reactive oxygen species (ROS), regulating renal Na+ handling and blood pressure. TALLYHO/JngJ (TH) mice are believed to mimic the state of obesity in humans with a polygenic background of type 2 diabetes. This present work is to investigate the role of Na/K-ATPase signaling in TH mice, focusing on susceptibility to hypertension due to chronic excess salt ingestion. Age-matched male TH and the control C57BL/6J (B6) mice were fed either normal diet or high salt diet (HS: 2, 4, and 8% NaCl) to construct the renal function curve. Na/K-ATPase signaling including c-Src and ERK1/2 phosphorylation, as well as protein carbonylation (a commonly used marker for enhanced ROS production), were assessed in the kidney cortex tissues by Western blot. Urinary and plasma Na+ levels were measured by flame photometry. When compared to B6 mice, TH mice developed salt-sensitive hypertension and responded to a high salt diet with a significant rise in systolic blood pressure indicative of a blunted pressure-natriuresis relationship. These findings were evidenced by a decrease in total and fractional Na+ excretion and a right-shifted renal function curve with a reduced slope. This salt-sensitive hypertension correlated with changes in the Na/K-ATPase signaling. Specifically, Na/K-ATPase signaling was not able to be stimulated by HS due to the activated baseline protein carbonylation, phosphorylation of c-Src and ERK1/2. These findings support the emerging view that Na/K-ATPase signaling contributes to metabolic disease and suggest that malfunction of the Na/K-ATPase signaling may promote the development of salt-sensitive hypertension in obesity. The increased basal level of renal Na/K-ATPase-dependent redox signaling may be responsible for the development of salt-sensitive hypertension in polygenic obese TH mice.
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Affiliation(s)
- Yanling Yan
- Departments of Clinical & Translational Sciences, Biomedical Sciences, and Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, USA.
| | - Jiayan Wang
- Departments of Clinical & Translational Sciences, Biomedical Sciences, and Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, USA
| | - Muhammad A Chaudhry
- Departments of Clinical & Translational Sciences, Biomedical Sciences, and Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, USA
| | - Ying Nie
- Departments of Clinical & Translational Sciences, Biomedical Sciences, and Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, USA
| | - Shuyan Sun
- Departments of Clinical & Translational Sciences, Biomedical Sciences, and Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, USA
- Hebei Medical University, Shijiazhuang 50017, China
| | - Jazmin Carmon
- Departments of Clinical & Translational Sciences, Biomedical Sciences, and Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, USA
| | - Preeya T Shah
- Departments of Clinical & Translational Sciences, Biomedical Sciences, and Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, USA
| | - Fang Bai
- Departments of Clinical & Translational Sciences, Biomedical Sciences, and Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, USA
| | - Rebecca Pratt
- Departments of Clinical & Translational Sciences, Biomedical Sciences, and Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, USA
| | - Cameron Brickman
- Departments of Clinical & Translational Sciences, Biomedical Sciences, and Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, USA
| | - Komal Sodhi
- Departments of Clinical & Translational Sciences, Biomedical Sciences, and Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, USA
| | - Jung Han Kim
- Departments of Clinical & Translational Sciences, Biomedical Sciences, and Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, USA
| | - Sandrine Pierre
- Departments of Clinical & Translational Sciences, Biomedical Sciences, and Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, USA
| | - Deepak Malhotra
- Department of Medicine, The University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614, USA
| | - Gary O Rankin
- Departments of Clinical & Translational Sciences, Biomedical Sciences, and Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, USA
| | - Zi-Jian Xie
- Departments of Clinical & Translational Sciences, Biomedical Sciences, and Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, USA
| | - Joseph I Shapiro
- Departments of Clinical & Translational Sciences, Biomedical Sciences, and Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, USA
| | - Jiang Liu
- Departments of Clinical & Translational Sciences, Biomedical Sciences, and Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, USA
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Kramer H. Kidney Disease and the Westernization and Industrialization of Food. Am J Kidney Dis 2017; 70:111-121. [DOI: 10.1053/j.ajkd.2016.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 11/01/2016] [Indexed: 01/12/2023]
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Suzuki M, Shindo D, Suzuki R, Shirataki Y, Waki H. Combined long-term caffeine intake and exercise inhibits the development of diabetic nephropathy in OLETF rats. J Appl Physiol (1985) 2017; 122:1321-1328. [PMID: 28235857 DOI: 10.1152/japplphysiol.00278.2016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 12/21/2016] [Accepted: 02/03/2017] [Indexed: 11/22/2022] Open
Abstract
This study was performed to examine the effects of long-term caffeine-intake, with and without exercise, on the progression of diabetic nephropathy (DN) in an obese diabetic rat model. Thirty-two male Otsuka Long-Evans Tokushima fatty (OLETF) rats were assigned to sedentary (OLETF-Sed), exercise (OLETF-Ex), caffeine-intake (OLETF-Caf), and combined (OLETF-Caf + Ex) groups. Caffeine-intake groups were fed rat chow containing caffeine (90.7 ± 4.7 mg/kg/day). The OLETF-Ex and OLETF-Caf + Ex groups were able to run voluntarily at any time using a rotatory wheel. Body weight (BW) and blood pressure (BP) were measured weekly from 24 to 29 wk of age. Pre- and posttreatment serum glucose, insulin, and creatinine concentrations were measured, and a 24 h urine sample was collected for measurement of creatinine clearance (Ccr) and albumin excretion (UEAlb). After treatment, the kidneys were removed for morphological analysis. The OLETF-Caf and OLETF-Caf + Ex groups exhibited no BP increase during the study. Both the caffeine-intake groups exhibited a significant increase in urine volume (UV), electrolyte excretion, and Ccr, and decreased UEAlb, following treatment. Furthermore, no structural damage was observed in the kidneys of rats from either caffeine-intake group, whereas the OLETF-Sed and OLETF-Ex groups exhibited DN progression. This study demonstrates that caffeine-intake alone and/or combined with exercise significantly decreases BW and improves glucose intolerance, without the progression of DN. Further research should be performed to examine whether the quantities of caffeine contained in a normal human daily intake also have a protective effect against kidney damage.NEW & NOTEWORTHY The present study showed that caffeine administration alone and/or combined with exercise results in an improvement of diabetic nephropathy (DN), including an increase in creatinine clearance and urinary Na excretion, a decrease in urinary protein excretion, and in renal morphological findings. To our knowledge, there are no other studies showing that caffeine administration inhibits DN progression.
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Affiliation(s)
- Masato Suzuki
- Department of Laboratory Medicine, The Jikei University School of Medicine, Nishi-shinbashi, Minato-ku, Tokyo, Japan;
| | - Daisuke Shindo
- Laboratory of Health and Sports Science, Department of Pharmacy, Nihon University, Narashinodai, Funabashi-shi, Chiba, Japan
| | - Ryuichiro Suzuki
- Department of Pharmacognosy and Natural Medicines, Faculty of Pharmaceutical Sciences, Josai University, Sakado, Saitama, Japan; and
| | - Yoshiaki Shirataki
- Department of Pharmacognosy and Natural Medicines, Faculty of Pharmaceutical Sciences, Josai University, Sakado, Saitama, Japan; and
| | - Hidefumi Waki
- Department of Physiology, Graduate School of Health and Sports Science, Juntendo University, Inzai, Chiba, Japan
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10
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Tsuboi N, Okabayashi Y, Shimizu A, Yokoo T. The Renal Pathology of Obesity. Kidney Int Rep 2017; 2:251-260. [PMID: 29142961 PMCID: PMC5678647 DOI: 10.1016/j.ekir.2017.01.007] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/16/2017] [Indexed: 01/25/2023] Open
Abstract
Obesity causes various structural, hemodynamic, and metabolic alterations in the kidney. Most of these are likely to be compensatory responses to the systemic increase in metabolic demand that is seen with obesity. In some cases, however, renal injury becomes clinically apparent as a result of compensatory failure. Obesity-related glomerulopathy is the best known of such disease states. Factors that may sensitize obese individuals to renal compensatory failure and associated injury include the severity and number of obesity-associated conditions or complications, including components of metabolic syndrome, and the mismatch of body size to nephron mass, due to nephron reductions of congenital or acquired origin.
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Affiliation(s)
- Nobuo Tsuboi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yusuke Okabayashi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.,Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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11
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12
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Chu MP, McCaw L, Stretch C, Butts C, Hanson J, Kuzma M, Damaraju VL, Baracos VE, Sawyer MB. Development of a new equation to estimate creatinine clearance in cancer patients. Cancer Chemother Pharmacol 2015; 76:117-24. [PMID: 25986679 DOI: 10.1007/s00280-015-2777-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 05/08/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Determining renal function is important for chemotherapy eligibility and dosing. Measured creatinine clearance (mCrCl) is the gold standard but is cumbersome. Equations estimating CrCl (eCrCl) based on serum creatinine (SCr) produce widely varying estimates. Considering that SCr is derived from skeletal muscle, this study prospectively developed a new eCrCl equation in cancer patients using CT-defined muscle surface area (MSA) and evaluated its utility in a separate, retrospective series. METHODS In a prospective, observational cohort study of cancer patients, mCrCl by 24-h urine collection was correlated with CT-determined MSA to create an equation for eCrCl [muscle surface area (cm(2)) × 42/SCr]. eCrCl by Wright, Cockcroft-Gault (CG), CKD-EPI, MDRD, and MSA was compared to mCrCl to determine fit. MSA-eCrCl was used to simulate carboplatin dosing in a retrospective series of advanced non-small cell lung cancer (NSCLC). RESULTS Prospectively, 22 patients were accrued and evaluable (12 males; median age 69). MSA-eCrCl correlated stronger (r (2) 0.80) than current equations (r (2) 0.47-0.69) with mCrCl. In calculating carboplatin doses for 89 NSCLC patients with MSA and CG-eCrCl, median error of CG-determined carboplatin dose was 5.5 % (range -19.0 to 44.2 %), assuming that MSA was better at estimating CrCl. Forty-two patients (47 %) received doses that varied ≥10 % of what was calculated by MSA. CONCLUSIONS We propose a new formula for eCrCl in patients that appears more accurate than current formulae and may have implications for chemotherapy efficacy and toxicity. Studies to validate this formula are under way.
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Affiliation(s)
- Michael P Chu
- Department of Oncology, Cross Cancer Institute, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada,
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13
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Felizardo RJF, Silva MBD, Aguiar CF, Câmara NOS. Obesity in kidney disease: A heavyweight opponent. World J Nephrol 2014; 3:50-63. [PMID: 25332896 PMCID: PMC4202492 DOI: 10.5527/wjn.v3.i3.50] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 04/18/2014] [Accepted: 06/11/2014] [Indexed: 02/05/2023] Open
Abstract
Obesity is an important worldwide challenge that must be faced in most developed and developing countries because of unhealthy nutritional habits. The consequences of obesity and being overweight are observed in different organs, but the kidney is one of the most affected. Excess adipose tissue causes hemodynamic alterations in the kidney that can result in renal disease. However, obesity is also commonly associated with other comorbidities such as chronic inflammation, hypertension and diabetes. This association of several aggravating factors is still a matter of concern in clinical and basic research because the pathophysiologic mechanisms surrounding chronic kidney disease development in obese patients remain unclear. This review will discuss the consequences of obesity in the context of renal injury.
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Renal outcomes of bariatric surgery in obese adults with diabetic kidney disease. J Nephrol 2014; 27:361-70. [DOI: 10.1007/s40620-014-0078-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 01/22/2014] [Indexed: 12/21/2022]
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15
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Fuke Y, Murata Y, Hemmi S, Kajiwara M, Yabuki M, Fujita T, Soma M. Secondary focal segmental glomerulosclerosis in an adolescent born with a very low birth weight. Intern Med 2014; 53:2233-6. [PMID: 25274236 DOI: 10.2169/internalmedicine.53.2552] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 17-year-old man presented with a decreased renal function (creatinine clearance 66.0 ml/min/1.73 m2) and proteinuria (1.25 g/24 hrs). He was born weighing 1,065 g 26 weeks of pregnancy. He was mildly overweight (BMI 26.9 kg/m2) due to an increased weight gain (10 kg) over the past year. Renal biopsy showed perihilar sclerosing lesions in three of eleven glomeruli, low glomerular density, enlarged glomeruli, and limited fusions of foot processes, thus indicating secondary focal segmental glomerulosclerosis (FSGS). We speculated that the patient's overweight status may have caused a worsening of glomerular hyperfiltration due to the fewer number of nephrons leading to the development of secondary FSGS.
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Affiliation(s)
- Yoshinobu Fuke
- Department of Medicine, Division of Nephrology, Hypertension and Endocrinology, Nihon University School of Medicine, Japan
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Abstract
BACKGROUND The prevalences of obesity and chronic kidney disease (CKD) have increased simultaneously. Should a pathophysiological relationship exist between the two conditions, bariatric surgery and associated weight loss could be an important intervention in extremely obese individuals to slow the progression of CKD. METHODS We conducted a retrospective analysis of 25 patients who had undergone biliopancreatic diversion (BPD) surgery for extreme obesity (body mass index >40 kg/m(2)), with mean follow-up of 4 years. We assessed pre- and post-surgery renal function, body weight and blood pressure (BP) obtained from electronic hospital and primary care records. RESULTS There was a significant reduction in mean body weight at 4 years by 50.3 kg (SD = 20.65). The creatinine and estimated glomerular filtration rate (eGFR) also improved significantly: serum creatinine reduced by 16.2 μmol/l (SD = 19.57) while the eGFR improved by 10.6 ml/min/m(2) (SD = 15.45). The greatest improvement in eGFR was in the group (n = 7) with eGFR ≤60 ml/min/m(2). A subset of patients (n = 11) had evaluable BP readings and had a reduction in BP of 17/10 mmHg (SD = 33/12). CONCLUSIONS This retrospective study demonstrates a clinically significant improvement in renal function following BPD. Several mechanisms including weight loss could account for the positive impact on renal function. The physiology underlying this improvement requires further study.
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Rana S, Karumanchi SA, Lindheimer MD. Angiogenic factors in diagnosis, management, and research in preeclampsia. Hypertension 2013; 63:198-202. [PMID: 24166749 DOI: 10.1161/hypertensionaha.113.02293] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Sarosh Rana
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Kirstein 382 Boston, MA 02215.
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18
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Abstract
Assessment of adiposity should include measurements of both body mass index and waist circumference. The prevalence of obesity, based on a body mass index of 30 kg/m(2) or greater, has increased substantially over the past 2 decades in Western societies. Obesity remains the number one preventable risk factor for chronic kidney disease because obesity largely mediates diabetes and hypertension, the 2 most common etiologies for end-stage kidney disease. However, obesity itself likely has independent effects on renal hemodynamics and individuals with a low number of nephrons are likely to be the most susceptible to these changes. Multiple mechanisms have been postulated whereby obesity directly impacts kidney disease including hyperfiltration, increased glomerular capillary wall tension, and podocyte stress. Weight loss reduces glomerular filtration rate and effective renal plasma flow along with proteinuria, but these changes are most notable after bariatric surgery in adults with morbid obesity. Aside from adiposity itself, the high caloric intake that leads to obesity also may heighten chronic kidney disease risk via the circuitous loop between Sirt1 and adiponectin and podocyte effacement. Sirt1 is a nicotinamide adenine dinucleotide+dependent deacteylase that is up-regulated in the setting of caloric restriction. Sirt1 expression modulates adiponectin levels that in turn appear to influence podocyte effacement. Clinical trials are needed to assess the benefits and risks of intentional weight loss on kidney disease measures and progression.
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Affiliation(s)
- Christopher Wickman
- Division of Nephrology and Hypertension, Loyola University Chicago, Maywood, IL 60153, USA
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Wang YL, Shu KH, Yang MF, Yang WC, Wu MJ, Lin TM, Chen CH. The impact of body weight management in chronic kidney disease patients with obesity. J Ren Nutr 2013; 23:372-9. [PMID: 23791421 DOI: 10.1053/j.jrn.2013.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 04/02/2013] [Accepted: 04/19/2013] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Chronic kidney disease (CKD) and obesity are important public health concerns. Because obesity may initiate and/or accelerate kidney damage, weight control may benefit CKD patients. DESIGN AND METHODS We examined the influence of dietary management and physical exercise in 38 obese CKD patients with or without target reduction of body weight 3% or more from baseline. RESULTS After a 2-month lifestyle intervention program, those with target body weight control had significant improvement of blood pressure control, as well as reduced lipid profiles, serum creatinine level (1.1 ± 0.3 vs. 0.8 ± 0.3; P < .001), estimated glomerular filtration rate (75.9 ± 21.2 vs. 104.9 ± 38.1; P < .001), and proteinuria (76.3% vs. 50.0%; P = .02). They had greater improvement in cardiorespiratory endurance in an 800-m running test (375.1 ± 64.7 vs. 327.1 ± 84.0 seconds; P = .001), better abdominal muscle strength and endurance in a timed sit-up test (13.6 ± 9.1 vs. 19.9 ± 9.2 number/minute; P = .005), and greater flexibility in a sit-and-reach test (18.8 ± 10.9 vs. 27.8 ± 10.9 cm; P < .001) comparing baseline and postintervention values. CONCLUSIONS A combination of dietary management and exercise were associated with improvements in health-related physical fitness, cardiovascular risk factors (blood pressure and lipid control), and renal profiles in obese CKD patients. Supportive individualized programs for lifestyle change could exert beneficial effects, but long-term research with a larger patient population is needed to elucidate the optimal effective combination of dietary management and exercise.
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Affiliation(s)
- Ya-Ling Wang
- Department of Food and Nutrition, Taichung Veterans General Hospital, Taichung, Taiwan
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Kanasaki K, Kitada M, Kanasaki M, Koya D. The biological consequence of obesity on the kidney. Nephrol Dial Transplant 2013; 28 Suppl 4:iv1-7. [PMID: 23743020 DOI: 10.1093/ndt/gft098] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Obesity is a worldwide epidemic that is associated with several health issues, including kidney diseases. A specific kidney disease, referred to as obesity-related glomerulopathy, has been described in earlier publications. Obesity can affect the prognosis of other types of kidney diseases. Body-weight reduction with caloric restriction is an essential therapy, although strictly controlling food intake coupled with an appropriate evaluation is challenging. Low birthweight can be an important factor for obesity and results in kidney dysfunction. In this review, we analyse the consequences of obesity on kidney prognosis and potential strategies for combating obesity-associated kidney injury.
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Affiliation(s)
- Keizo Kanasaki
- Division of Diabetology and Endocrinology, Kanazawa Medical University, Uchinada, Ishikawa, Japan
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21
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Abstract
We performed a critical review focused on the main non-oncologic disorders that have a strong, direct association with obesity: chronic kidney disease, kidney stones and female and male lower urinary tract symptoms/disorders. We discuss the epidemiology, pathogenesis and therapeutic aspects regarding the association between obesity and non-diabetic and non-hypertensive forms of chronic kidney disease directly caused or worsened by weight excess, with particular attention on obesity-related glomerulopathy (ORG), which is typical of severe obesity, and the consequences of intentional weight loss on proteinuria and glomerular filtration rate. The associations of obesity with kidney stones and lower urinary tract conditions are also discussed from the epidemiological, physiopathological and therapeutical points of view, with emphasis on the principal concerns raised by the heterogeneity of study designs and outcome definitions typical of research in these fields. We also call attention to important clinical and scientific questions that should be addressed by future research.
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Affiliation(s)
- Anita Morandi
- Complex Operative Unit of Pediatric Diabetes, Clinical Nutrition and Obesity, Department of Life and Reproduction Sciences, University of Verona, Via Bengasi, 4, 37134 Verona, Italy
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Kramer H. Dietary patterns, calories, and kidney disease. Adv Chronic Kidney Dis 2013; 20:135-40. [PMID: 23439372 DOI: 10.1053/j.ackd.2012.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 11/20/2012] [Accepted: 12/10/2012] [Indexed: 12/17/2022]
Abstract
Specific nutritional factors that mediate obesity or CKD remain very difficult to quantify in any population. That being said, several macronutrients, including protein intake, have been examined as risk factors for CKD progression. Given the correlation of micro- and macronutrients within a particular diet and the consistency of an individual's dietary habits over time for most individuals, dietary patterns may have a greater impact on CKD risk and progression. This review focuses on dietary patterns and their association with CKD. To date, studies examining dietary patterns and CKD risk remain very limited, and more studies are needed. However, the follow-up period may need to be fairly long to detect any association. Caloric intake itself may also affect CKD risk. This may be due to the influence of caloric intake on sirtuin1, which modulates adiponectin gene expression and nitric oxide bioavailability.
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Medaka fish, Oryzias latipes, as a model for human obesity-related glomerulopathy. Biochem Biophys Res Commun 2013; 431:712-7. [PMID: 23353086 DOI: 10.1016/j.bbrc.2013.01.053] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 01/12/2013] [Indexed: 01/10/2023]
Abstract
Obesity, an ongoing significant public health problem, is a part of complex disease characterized as metabolic syndrome. Medaka and zebrafish are useful aquatic experimental animals widely used in the field of toxicology and environmental health sciences and as a human disease models. In medaka, simple feeding of a high fat diet (HFD) can induce body weight gain, excessive accumulation of visceral adipose tissue, hyperglycemia, hyperlipidemia, and steatohepatitis, which mimics human metabolic syndrome. In the present study, to explore the possibility that the adult medaka fed with HFD (HFD-medaka) can be used as an animal model for human metabolic syndrome-associated glomerular disease, including obesity-related glomerulopathy (ORG), we analyzed structural alterations and protein expression in the mesonephric kidney of HFD-medaka. We found that the histopathology was consistent with glomerulomegaly accompanied by the dilation of glomerular capillaries and proliferative expansion of the mesangium, a condition partially comparable to human ORG. Moreover, expressions of several kinds of kidney disease-related proteins (such as MYH9, SM22α) were significantly elevated. Thus, the HFD-medaka has a high potential as an animal model useful for exploring the mechanism underling human ORG.
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Sato-Horiguchi C, Ogawa D, Wada J, Tachibana H, Kodera R, Eguchi J, Nakatsuka A, Terami N, Shikata K, Makino H. Telmisartan attenuates diabetic nephropathy by suppressing oxidative stress in db/db mice. Nephron Clin Pract 2013; 121:e97-e108. [PMID: 23307263 DOI: 10.1159/000343102] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 08/24/2012] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND/AIMS Telmisartan, an angiotensin II type 1 receptor blocker, is widely used to treat hypertension and kidney diseases, including diabetic nephropathy, because of its renoprotective effects. However, the mechanism by which telmisartan prevents proteinuria and renal dysfunction in diabetic nephropathy is still unclear. In this study, we examined the effects of telmisartan against diabetic nephropathy in db/db mice. METHODS Telmisartan was administered at a dose of 5 mg/kg/day for 3 weeks to db/db (diabetic) and db/m (control) mice. Urinary albumin excretion, renal histology, and the gene expression of oxidative stress and inflammatory markers in renal tissue were determined. To evaluate the effects of telmisartan on reactive oxygen species (ROS) production, superoxide was detected by dihydroethidium (DHE) staining in vivo and in vitro. RESULTS Telmisartan reduced albuminuria, mesangial matrix expansion, macrophage infiltration, and the expression of ROS markers (NADPH oxidase 4- and 8-hydroxydeoxyguanosine) and inflammatory cytokines (monocyte chemoattractant protein-1, osteopontin, and transforming growth factor-β) in the kidney. DHE staining showed that telmisartan decreased ROS generation in the kidney and in cultured mesangial and proximal tubular epithelial cells. CONCLUSIONS Taken together, these findings indicate that telmisartan protects against diabetic nephropathy by reducing diabetes-induced oxidative stress.
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Affiliation(s)
- Chikage Sato-Horiguchi
- Department of Medicine and Clinical Science, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
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27
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Abstract
Obesity and diabetes are major causes of CKD and ESRD, and are thus enormous health concerns worldwide. Both obesity and diabetes, along with other elements of the metabolic syndrome including hypertension, are highly interrelated and contribute to the development and progression of renal disease. Studies show that multiple factors act in concert to initially cause renal vasodilation, glomerular hyperfiltration, and albuminuria, leading to the development of glomerulopathy. The coexistence of hypertension contributes to the disease progression, which, if not treated, may lead to ESRD. Although early intervention and management of body weight, hyperglycemia, and hypertension are imperative, novel therapeutic approaches are also necessary to reduce the high morbidity and mortality associated with both obesity-related and diabetes-related renal disease.
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Affiliation(s)
- Christine Maric-Bilkan
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS 39216-4505, USA.
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29
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Abstract
Several epidemiologic investigations have confirmed that obesity is a significant risk factor for the appearance of proteinuria and end-stage kidney disease in a normal population. Weight loss induced by low-calorie diets, physical exercise, or bariatric surgery is accompanied by an important antiproteinuric effect. Reduction in proteinuria is already observed after a few weeks from the onset of weight loss and it is evident even in patients with modest weight losses. Reduction in proteinuria by weight loss has been described in chronic proteinuric nephropathies of different etiologies. The mechanisms through which weight loss may reverse proteinuria are likely to be plural: better control of blood pressure, improvement of serum lipid profile, improvement of insulin sensitivity, better glycemic control in diabetes patients, decrease of circulating leptin levels, reversal of glomerular hyperfiltration, and decreased activation of the renin-angiotensin-aldosterone system.
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Affiliation(s)
- Enrique Morales
- Nephrology Department, Hospital 12 de Octubre, Avda. Andalucía s/n., Madrid, 28231, Spain.
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Hobbs H, Farmer C, Irving J, Klebe B, Stevens P. Is high body mass index independently associated with diminished glomerular filtration rate? An epidemiological study. J Ren Care 2012; 37:148-54. [PMID: 21810196 DOI: 10.1111/j.1755-6686.2011.00231.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To examine whether there is an independent association between body mass index (BMI) and estimated glomerular filtration rate (GFR) in a large primary care population. METHODS Anonymous data were sequentially extracted from primary care records between 2006 and 2009 in a primary care population of approximately 220,000 people in Kent, South East UK. Using GFR, BMI, age, gender and comorbidities we examined the association between BMI and GFR. Univariate and multivariate analysis was performed using SPSS(®) (SPSS Inc., Chicago). RESULTS Sixty-one thousand six-hundred thirty seven people fulfilled the inclusion criteria. There was no correlation between BMI and GFR on univariate analysis. When stratified by BMI, ANOVA demonstrated a statistically significant difference in GFR across BMI strata (p < 0.001). However the absolute differences in BMI between groups were very small. There was a small association between BMI and GFR on multivariate analysis, much of which was lost on adjustment for confounding variables. CONCLUSION These findings suggest that elevated BMI is not a biologically significant predictor of diminished GFR and therefore may be an insufficiently accurate measure of risk for the metabolic syndrome and CKD.
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Affiliation(s)
- Helen Hobbs
- East Kent Hospitals University NHS Foundation Trust, Kent Kidney Care Centre, Kent CT1 3NG, UK
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31
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Camici M, Galetta F, Abraham N, Carpi A. Obesity-related glomerulopathy and podocyte injury: a mini review. Front Biosci (Elite Ed) 2012. [PMID: 22201936 DOI: 10.2741/441] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Obesity-related glomerulopathy (ORG) is morphologically defined as focal segmental glomerulosclerosis and glomerulomegaly. Podocyte hypertrophy and reduced density are related to proteinuria which in a portion of patients is in the nephrotic range and evolvs towards renal failure. This article reviews the pathogenetic mechanisms of podocyte injury or dysfunction and lists new possible antiproteinuric strategies based on pharmaceutical targeting of the reported pathogenetic mechanisms. The pathogenetic mechnisms discussed include: renin angiotensin system, plasminogen activation inhibitor-1 (PAI-1), lipid metabolism, adiponectin, macrophages and proinflammatory cytokines, oxidative stress. The proposed antiproteinuric strategies include: AT2 receptor blockers; adipokine complement C19 TNF-related protein-1 blocker; selective PAI-1 inhibitor; farnesoid x receptor activation; increase of circulating adiponectin; selective antiinflammatory drugs; more potent antioxidants (Heme oxigenase, NOX4 inhibitors). However, because ORG is a rare disease, the need for a long term pharmaceutical approach in obese proteinuric patients should be carefully evaluated and limited to the cases with progressive loss of renal function.
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Holecki M, Chudek J, Więcek A, Titz-Bober M, Duława J. The serum level of fibroblast growth factor-23 and calcium-phosphate homeostasis in obese perimenopausal women. Int J Endocrinol 2011; 2011:707126. [PMID: 22164160 PMCID: PMC3227462 DOI: 10.1155/2011/707126] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 10/18/2011] [Accepted: 10/18/2011] [Indexed: 11/17/2022] Open
Abstract
Plasma FGF-23 concentrations and its relationship with calcium-phosphate homeostasis were evaluated in 48 perimenopausal obese women and in 29 nonobese controls. Serum parathyroid hormone, 25-hydroxyvitamin D(3), CTX1, osteocalcin, total calcium, phosphorus, creatinine, and plasma intact FGF-23 concentrations were assessed. DXA of lumbar spine and femoral neck was performed to determine bone mineral density (BMD). Plasma iFGF-23 concentration was significantly higher in obese patients (by 42%) and correlated with age and BMD of proximal femur (R = -0.346; R = 0.285, resp.) but not with markers of bone turnover. However, serum phosphorus level in obese subjects was significantly lower. iFGF-23 concentration correlated significantly with body mass index (R = 0.292) and fat content (R = 0.259) in all study subjects. Moreover, a significant correlation between iFGF-23 and iPTH (R = 0.254) was found. No correlation between serum phosphorus or eGFR and plasma iFGF-23 and between eGFR and serum phosphorus was found. Elevated serum iFGF-23 concentration may partially explain lower phosphorus levels in the obese and seems not to reflect bone turnover.
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Affiliation(s)
- M. Holecki
- Department of Internal Medicine and Metabolic Diseases, Medical University of Silesia, ul. Ziołowa 45/47, 40-635 Katowice, Poland
| | - J. Chudek
- Department of Pathophysiology, Medical University of Silesia, ul. Medyków 18, 40-752 Katowice, Poland
| | - A. Więcek
- Department of Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia, ul. Francuska 20-24, 40-027 Katowice, Poland
| | - M. Titz-Bober
- Department of Internal Medicine and Metabolic Diseases, Medical University of Silesia, ul. Ziołowa 45/47, 40-635 Katowice, Poland
| | - J. Duława
- Department of Internal Medicine and Metabolic Diseases, Medical University of Silesia, ul. Ziołowa 45/47, 40-635 Katowice, Poland
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Abstract
The aging process affects all organs, including the kidneys. As part of this process, progressive scarring and a measurable decline in renal function occur in most people over time. The improved understanding of the processes that can lead to and/or hasten scarring and loss of renal function over time parallels advances in our understanding of the aging process. Clinical factors, including hypertension, diabetes mellitus, obesity, abnormal lipid levels and vitamin D deficiency, have been associated with increasing renal sclerosis with age. In addition, tissue factors such as angiotensin II, advanced glycation end products, oxidative stress and Klotho are associated with renal aging. These associations and possible interventions, including the control of blood pressure, blood sugar, weight, diet and calorie restriction might make renal aging more preventable than inevitable.
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Sowers JR, Whaley-Connell A, Hayden MR. The Role of Overweight and Obesity in the Cardiorenal Syndrome. Cardiorenal Med 2011; 1:5-12. [PMID: 22258461 DOI: 10.1159/000322822] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The presence of a group of interactive maladaptive factors including hypertension, insulin resistance, metabolic dyslipidemia, obesity, microalbuminuria, and/or reduced renal function constitute the cardiorenal metabolic syndrome (CRS). Overweight, obesity, and chronic kidney disease (CKD) have grown to pandemic proportions in industrialized countries during the past decade. The fact that these interactive factors promote heart and renal disease has been documented in large population-based studies. Obesity seems to be the driving force behind the development of heart disease and CKD and therefore the CRS. The relationship between overweight/obesity and kidney disease begins in early childhood and appears to be related to overconsumption of high-fructose corn syrup and insufficient physical activity. Today, 13 million children are obese, and over 70% of these children are likely to become obese adults. Indeed, approximately 30% of male and 34% of female adults in the United States are obese. This lifestyle-related epidemic will be a major societal medical and economic problem that will accentuate the current epidemic of CKD in the United States and other industrialized and emerging industrialized countries. In this article, we will review the potential mechanisms by which obesity and other metabolic abnormalities interact to promote heart and progressive kidney disease.
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Schuster DP, Teodorescu M, Mikami D, Foreman K, Rogers P, Needleman BJ. Effect of bariatric surgery on normal and abnormal renal function. Surg Obes Relat Dis 2010; 7:459-64. [PMID: 21273140 DOI: 10.1016/j.soard.2010.11.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 10/18/2010] [Accepted: 11/12/2010] [Indexed: 12/18/2022]
Abstract
BACKGROUND Obesity has been associated with hypertension, diabetes mellitus, and metabolic syndrome, risk factors for chronic kidney disease. In addition, obesity has been found to have an independent, negative effect on renal function and the progression of renal insufficiency. METHODS The serum creatinine (CR) in 813 patients who had undergone obesity surgery from 2003 to 2009 at a large academic medical center and had been followed up for ≥24 months was retrospectively monitored. Renal function, as measured by the CR level, was assessed at baseline and at 6, 12, and ≥24 months of follow-up. The groups were stratified by the baseline CR as follows: normal (CR <1.3 mg/dL), mild impairment (CR 1.3-1.6 mg/dL), and moderate impairment (CR >1.6 mg/dL). RESULTS Of the 813 patients, 757 had a CR <1.3 mg/dL at baseline. Of those 757 patients, 97.6% had maintained a CR of <1.3 mg/dL, 1.3% had a CR of 1.3-1.6 mg/dL, 1.1% had a CR of >1.6 mg/dL (n = 757) at 6 months of follow-up. At 1 year of follow-up, 99% had maintained a CR of <1.3 mg/dL and 1% had a CR of >1.3% (n = 509). At 2 years of follow-up, 100% had a CR value of <1.3 mg/dL (n = 388). Of the remaining 56 patients, 71.4% had been classified as having mild impairment (CR 1.3-1.6 mg/dL) and 28.5% as having moderate impairment (CR >1.6 mg/dL) before weight loss surgery. Examination of the CR values at ≥2 years after weight loss surgery demonstrated that 76.7% had a normal CR level, 12.5% had mild impairment, and 10.7% had moderate impairment. CONCLUSION Bariatric surgery does not have a negative effect on renal function as measured by the CR, whether CR at baseline is <1.3 or ≥1.3 mg/dL when monitored for ≥24 months. For those with impaired renal function and a CR ≥1.3 mg/dL, improvement in CR was seen in 76.7% at ≥2 years postoperatively, at a point at which the weight loss velocity, hydration, and nutritional status have stabilized. The weight loss associated with bariatric surgery could potentially have a positive effect on renal function at ≥24 months, such as was found in the present study by a stable or reduced CR level. The etiology for this might be a direct effect of weight loss on impaired renal function or an indirect effect by reducing the rates of co-morbidities, such as diabetes mellitus and hypertension, both risk factors for renal disease. Additional prospective studies, including weight-matched controls, are needed.
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Affiliation(s)
- D P Schuster
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ohio State University Hospitals, Columbus, Ohio, USA.
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Matsumoto H, Nakao T, Okada T, Nagaoka Y, Wada T, Gondo A, Esaki S, Miyaoka Y, Nango T. Benefits of staple food restriction for Japanese obese patients with chronic kidney disease: a pilot study. J Ren Nutr 2010; 21:340-6. [PMID: 20833071 DOI: 10.1053/j.jrn.2010.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 05/11/2010] [Accepted: 05/13/2010] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE We conducted a pilot study to assess the effects of dietary intervention on metabolic risk factors and renal parameters in obese patients with chronic kidney disease (CKD). METHODS We studied 19 obese patients with CKD at our outpatient clinic. The diet selected for this study restricted only their staple food intake, with no change in the side dish component of their meals. We studied neither the lifestyles of the patients nor the activities that they were involved in. We examined changes in clinical and laboratory parameters at baseline and after consumption of the diet. RESULTS After 2 and 6 months of staple food restriction, changes in body weight were found to be -3.6% ± 3.9% and -3.4% ± 4.7%, respectively. Of the 19 patients, the body weights of 9 decreased by >3% (range: 3.4% to 17.1%) from baseline to follow-up at 6 months. After 6 months of following the diet, these 9 patients showed marked reductions in blood pressure, homeostasis model assessment insulin resistance, and triglycerides, when compared with the remaining 10 patients with stable body weights; however, for proteinuria and estimated glomerular filtration rate they reported having values similar to the 10 patients with stable body weights. CONCLUSIONS Weight reduction associated with a lowered insulin resistance was reported in obese patients with CKD after 6 months of staple food restriction; however, further studies need to be conducted to confirm the presence of other possible renal benefits.
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Levey AS, Kramer H. Obesity, Glomerular Hyperfiltration, and the Surface Area Correction. Am J Kidney Dis 2010; 56:255-8. [DOI: 10.1053/j.ajkd.2010.06.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 06/10/2010] [Indexed: 11/11/2022]
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Roux-en-Y gastric bypass reverses renal glomerular but not tubular abnormalities in excessively obese diabetics. Surgery 2009; 147:282-7. [PMID: 20004430 DOI: 10.1016/j.surg.2009.09.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Accepted: 09/18/2009] [Indexed: 01/22/2023]
Abstract
BACKGROUND Obesity and type 2 diabetes are associated with renal dysfunction, which improves after Roux-en-Y gastric bypass (RYGB). During a 12-month follow-up period, we studied prospectively the changes in glomerular and tubular functions that occurred in excessively obese diabetic and non diabetic subjects after RYGB. METHODS The cohort included 35 patients, 54% of whom had type 2 diabetes. Glomerular filtration rate (GFR) was estimated using creatinine clearance. Tubular function was studied by measuring the ratio of urinary cystatin C to urinary creatinine (UCC ratio). RESULTS Baseline renal parameters, anthropometric characteristics, and changes in body mass index after the surgical procedures were similar between the 2 cohorts. At 12 months after RYGB, creatinine clearance decreased 15% in diabetics (P = .02) and 21% in nondiabetics (P = .03). A change in GFR was seen earlier in the nondiabetics (-29% after 6 months; P = .003). The UCC ratio was increased at both 6- and 12-month follow-ups (P = .03 and .003, respectively) only in the diabetic group. CONCLUSION GFR was improved at 12 months after RYGB, with nondiabetics showing a greater propensity score. Tubular function remained unchanged in the nondiabetic subjects, but worsening occurred in the diabetic subjects. These results underscore the importance of reversal of excessive obesity before the onset of frank diabetes.
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Watanabe D, Tanabe A, Naruse M, Morikawa S, Ezaki T, Takano K. Renoprotective effects of an angiotensin II receptor blocker in experimental model rats with hypertension and metabolic disorders. Hypertens Res 2009; 32:807-15. [DOI: 10.1038/hr.2009.106] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Although the negative effect of increased body mass index on kidney has been examined, the relation between other anthropometric measurements and kidney functions has not been investigated sufficiently. This study looks at the influence of anthropometric measurements on kidney functions. Forty patients were included in the study. Patients who had increased or normal anthropometric measurements were compared by serum levels of the urea, creatinine, albumin, 24 hr urine creatinine clearance, and urinary albumin excretion rate (UAER). Of all patients, 22 (55%) had an increased body mass index (BMI), 19 (47.5%) had an increased waist circumference (WC), and 24 (60%) had an increased waist-hip ratio (WHR). Subjects with increased BMI, WC, and WHR had significantly higher levels of serum creatinine and UAER than the subjects with normal measurements. The relation between CC and BMI was statistically significant only among the anthropometric measurements (p = 0.026). The ratio of microalbuminuria was 27.3%, 21.1%, and 29.2% in persons with increased BMI, WC, and WHR, respectively. Increases of anthropometric measurements affect kidney functions negatively. However, the influence of BMI on kidney function is more prominent. For this reason; individuals with increased anthropometric measurements should be monitored closely in terms of renal functions additional to cardiovascular risk factors.
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Affiliation(s)
- Eyup Koc
- Division of Nephrology, Gazi University, Faculty of Medicine, 4/2 Umitoy, Ankara, Turkey.
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Noori N, Hosseinpanah F, Nasiri AA, Azizi F. Comparison of overall obesity and abdominal adiposity in predicting chronic kidney disease incidence among adults. J Ren Nutr 2009; 19:228-37. [PMID: 19261489 DOI: 10.1053/j.jrn.2008.11.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Epidemiological data on the association between different aspects of adiposity and the risk for chronic kidney disease (CKD) in a cohort are limited. We compared the independent power of waist circumference (WC), waist-to-hip ratio (WHR), and body mass index (BMI) in predicting CKD in a large cohort of adults. DESIGN This was a population-based cohort study. SETTING, PARTICIPANTS, AND MEASUREMENTS A representative sample of 3107 subjects (1309 men and 1798 women), aged over 20 years, and free of CKD at baseline, was followed for 7 years. METHODS We estimated glomerular filtration rate (GFR) by using the abbreviated equation from the Modification of Diet in Renal Disease Study, and defined CKD as an estimated GFR of less than 60 mL/min/1.73 m(2). Adjusted relative hazards of CKD were modeled using Cox proportional hazards regression, including BMI, WC, and WHR as risk factors. RESULTS During the 7-year follow-up (median of 2183 days), 13.5% of participants (n = 419) developed CKD. The WC was positively related to risk of CKD, after multivariable adjustment for age, sex, smoking, menopause, physical activity, blood pressure, prevalent and incident diabetes, and change in WC during study period: Hazard ratios for CKD incidence were 1.00 (reference), 1.60 (95% CI: 1.06, 2.42), 1.86 (0.95 CI: 1.21, 2.85), and 1.88 (0.95 CI: 1.17, 3.01) for WC categories 1 to 4, respectively (P for trend < .02). The WHR was not independently associated with CKD. The rate of GFR decline (measured in mL/min/1.73 m(2)/year) was associated with baseline waist categories: regression coefficient for 1 SD increase in WC = -0.18 (0.95 CI:-0.28, -0.07). Based on Harrell's measure of concordance statistics, baseline WC was a better predictor of CKD than WHR (P < .05) and BMI (P < .05). CONCLUSIONS Abdominal adiposity measured with WC, irrespective of general adiposity, is a more important determinant of CKD risk in adults than are WHR and BMI.
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Affiliation(s)
- Nazanin Noori
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University, Tehran, Iran
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Serra A, Romero R, Lopez D, Navarro M, Esteve A, Perez N, Alastrue A, Ariza A. Renal injury in the extremely obese patients with normal renal function. Kidney Int 2008; 73:947-55. [DOI: 10.1038/sj.ki.5002796] [Citation(s) in RCA: 165] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Griffin KA, Kramer H, Bidani AK. Adverse renal consequences of obesity. Am J Physiol Renal Physiol 2008; 294:F685-96. [PMID: 18234955 DOI: 10.1152/ajprenal.00324.2007] [Citation(s) in RCA: 178] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Emerging evidence indicates that obesity, even in the absence of diabetes, contributes significantly to the development and progression of chronic kidney disease (CKD). Glomerular hyperfiltration/hypertrophy in response to the increased metabolic needs of obesity are postulated to lead to the development of glomerulosclerosis (GS) in a manner analogous to that in reduced renal mass states. Nevertheless, the individual risk for developing GS with obesity is very low. It is proposed that glomerular hyperfiltration/hypertrophy are per se not pathogenic in the absence of an enhanced glomerular blood pressure (BP) transmission, and the modest preglomerular vasodilation that is likely present in the large majority of obese individuals is not sufficient to result in such increased BP transmission. However, in the small subset of obese individuals who are also born with a substantially reduced nephron number, there is a greater risk of enhanced glomerular BP transmission due to the substantially greater preglomerular vasodilation. Of perhaps greater clinical importance, similar additive deleterious effects of obesity on BP transmission would be expected in individuals with reduced renal mass, either congenital or acquired, or with concurrent renal disease, leading to accelerated progression. Of note, a low birth weight may be a risk factor for not only reduced nephron numbers at birth, but also for obesity and hypertension, resulting in a clustering of risk factors for progressive GS. Therefore, even though the individual risk for developing obesity GS is low, the cumulative impact of obesity on the public health burden of CKD is likely to be large because of its huge prevalence.
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Affiliation(s)
- Karen A Griffin
- Loyola Univ. Medical Center, 2160 South First Ave., Maywood, IL 60153, USA.
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Relación entre obesidad y desarrollo de insuficiencia renal. HIPERTENSION Y RIESGO VASCULAR 2008. [DOI: 10.1016/s1889-1837(08)71738-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Cignarelli M, Lamacchia O. Obesity and kidney disease. Nutr Metab Cardiovasc Dis 2007; 17:757-762. [PMID: 17606365 DOI: 10.1016/j.numecd.2007.03.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Revised: 03/07/2007] [Accepted: 03/13/2007] [Indexed: 10/23/2022]
Abstract
The prevalence of obesity worldwide has increased dramatically. Besides, an approximately two-fold higher rate of increase in mean BMI among the incident ESRD has been reported in the US population from 1995-2002. Chronic kidney disease (CKD) prevalence increases from 2.9% among adults with an ideal BMI to 4.5% among obese adults. The development of CKD is usually the culminating result of the interaction of multiple risk factors. Obesity represents one example of a multitoxicity state and given the background of genetic susceptibility and/or reduced nephron number, overweight may initiate renal remodeling and/or accelerate kidney failure. Obesity may be the number one preventable risk factor for CKD. Weight loss has indeed been shown to improve glomerular hemodynamics and reduce urine albumin excretion. Thus, obese patients with CKD should be counseled on the benefits of weight loss.
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Affiliation(s)
- Mauro Cignarelli
- Unit of Endocrinology and Metabolic Diseases, Department of Medical Sciences, University of Foggia, Via Luigi Pinto 1, 71100 Foggia, Italy.
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Karuparthi PR, Yerram P, Saab G, McFarlane SI, Whaley-Connell A. Obesity and chronic kidney disease: therapeutic implications. ACTA ACUST UNITED AC 2007. [DOI: 10.2217/14750708.4.5.585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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47
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Torun D, Ozelsancak R, Turan I, Micozkadioglu H, Sezer S, Ozdemir FN. The Relationship Between Obesity and Transforming Growth Factor Beta on Renal Damage in Essential Hypertension. Int Heart J 2007; 48:733-41. [DOI: 10.1536/ihj.48.733] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Dilek Torun
- Department of Nephrology, Baskent University Faculty of Medicine
| | - Ruya Ozelsancak
- Department of Nephrology, Baskent University Faculty of Medicine
| | - Inci Turan
- Department of Family Medicine, Baskent University Faculty of Medicine
| | | | - Siren Sezer
- Department of Nephrology, Baskent University Faculty of Medicine
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Speckman RA, McClellan WM, Volkova NV, Jurkovitz CT, Satko SG, Schoolwerth AC, Freedman BI. Obesity is associated with family history of ESRD in incident dialysis patients. Am J Kidney Dis 2006; 48:50-8. [PMID: 16797386 DOI: 10.1053/j.ajkd.2006.03.086] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2005] [Accepted: 03/23/2006] [Indexed: 11/11/2022]
Abstract
BACKGROUND Obesity is an established risk factor for chronic kidney disease and aggregates in families. The objective of this study is to examine the relationship between obesity and family history of end-stage renal disease (ESRD). METHODS Data were collected from 25,883 incident patients with ESRD in US ESRD Network 6 (Georgia, North Carolina, and South Carolina) dialysis clinics between 1995 and 2003. Family history is defined as a first- or second-degree relative with ESRD. Body mass index (BMI) at dialysis therapy initiation was classified as underweight (BMI < 18.5 kg/m2), normal (BMI, 18.5 to <25 kg/m2), overweight (BMI, 25 to < 30 kg/m2), obese (BMI, 30 to <35 kg/m2), or morbidly obese (BMI > or = 35 kg/m2). RESULTS Twenty-three percent of patients reported a family history of ESRD. Of patients reporting a family history of ESRD, 5.5% were underweight, 32.5% had normal BMI, 28.0% were overweight, 17.3% were obese, and 16.7% were morbidly obese. After controlling for age, race, sex, primary cause of ESRD, history of diabetes, history of hypertension, and estimated glomerular filtration rate at dialysis therapy initiation, reported family history of ESRD was associated with being overweight (odds ratio [OR], 1.17; 95% confidence interval [CI], 1.08 to 1.26), obese (OR, 1.25; 95% CI, 1.14 to 1.37), and morbidly obese (OR, 1.40; 95% CI, 1.27 to 1.55). CONCLUSION Obesity at dialysis therapy initiation was associated independently with reported family history of ESRD. This finding suggests that behavioral factors, adiposity-related genes, and gene-by-BMI interaction may contribute to familial risk for ESRD. This finding also suggests that management of obesity may be even more important for patients with a family history of ESRD than for the general population.
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Affiliation(s)
- Rebecca A Speckman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
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Lee MPS, Orlov D, Sweeney G. Leptin induces rat glomerular mesangial cell hypertrophy, but does not regulate hyperplasia or apoptosis. Int J Obes (Lond) 2006; 29:1395-401. [PMID: 15997243 DOI: 10.1038/sj.ijo.0803031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE There is an increased incidence of renal glomerulosclerosis in obese individuals. One of the major structural changes observed in nephropathy is the increase in kidney size, which may occur due to hypertrophy or changes in the rate of hyperplasia or apoptosis. Here we investigated whether leptin, the product of the obese (ob) gene which is found at high plasma levels in obese and diabetic individuals, alters any of these parameters. RESULTS We show that leptin increased hypertrophy of these cells. This was indicated by an approximately 33% increase in cell size and 40% increase in leucine incorporation. Furthermore, we show that the hypertrophic effect of leptin was mediated via PI 3-kinase and ERK1/2 by using the inhibitors LY294002 and PD98059, respectively. We also confirm that leptin activates both PI 3-kinase and ERK1/2 in these cells. We show that hyperplasia was not affected by leptin by measuring rat glomerular mesangial cell number and by assessing bromodeoxyuridine uptake. Leptin also did not alter caspase 3-like activity under control conditions or upon induction of apoptosis by ultraviolet light, suggesting that apoptosis was not regulated by leptin in these cells. CONCLUSION Our results show that leptin induced glomerular mesangial cell hypertrophy via PI 3-kinase and ERK1/2, and that hyperplasia and apoptosis were not altered by leptin. The hypertrophic effect of leptin may play a role in the pathophysiology of nephropathy associated with obesity.
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Affiliation(s)
- M P-S Lee
- Department of Biology, York University, Toronto, Canada
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Musso C, Javor E, Cochran E, Balow JE, Gorden P. Spectrum of Renal Diseases Associated with Extreme Forms of Insulin Resistance. Clin J Am Soc Nephrol 2006; 1:616-22. [PMID: 17699267 DOI: 10.2215/cjn.01271005] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Diabetic nephropathy is the leading cause of ESRD in the United States. Why the pathogenic mechanisms lead to nephropathy in certain patients with type 1 and 2 diabetes and spare others is unclear, but it is clear that hyperglycemia and glomerular hyperfiltration are important factors. In patients with syndromes of extreme insulin resistance, proteinuric forms of renal disease are common, but it is surprising to find that the renal pathology usually is not diabetic nephropathy. For instance, in the lipodystrophy syndromes, membranoproliferative glomerulonephritis type 1 and type 2, focal segmental glomerulosclerosis, and also diabetic nephropathy are seen. In the syndromes of autoantibodies to the insulin receptor, the various forms of lupus glomerulonephritis are seen. Even in patients with type 2 diabetes, the renal pathology may not be diabetic nephropathy. Therefore, in patients with syndromic forms of insulin resistance and type 2 diabetes, renal biopsy has an important role in defining the pathology that leads to proteinuric nephropathy and in formulating a therapeutic approach. It is the purpose of this article to review these unusual aspects of proteinuric nephropathy in patients with diabetes.
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Affiliation(s)
- Carla Musso
- Clinical Endocrinology Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892-1770, USA
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