Obesity and diabetic kidney disease

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.

Figure 1. Clustering of risk factors for obesity-related renal disease

Obesity, type 2 diabetes (T2DM), hypertension (HT) and cardiovascular disease (CVD) are all risk factors for chronic kidney disease (CKD) and end-stage renal disease (ESRD). The presence of one or more of these risk factors multiplies the overall risk for disease development and progression.

Figure 2. Interaction between metabolic and hemodynamic pathways in the pathophysiology of obesity-and diabetes-related renal disease

Abbreviations: SNS: sympathetic nervous system; RAAS, renin angiotensin aldosterone system; P_Gc, intraglomerular capillary pressure.

Figure 3. Mechanisms of obesity-related glomerulopathy

Abbreviations: TNF-α: tumor necrosis facor-α; IL-6, interleukin-6 system; CRP, C-reactive protein; CRP, MCP-1, monocyte chemoattractant protein-1; RAAS, renin angiotensin aldosterone system.