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Ivano VK, Hatto M, Teramoto F, Macedo PRAD, Gestic MA, Utrini MP, Chaim FDM, Ramos AC, Callejas-Neto F, Chaim EA, Cazzo E. Effects of bariatric surgery on renal function: a retrospective cohort study comparing one-year outcomes between one-anastomosis gastric bypass and Roux-en-Y gastric bypass. SAO PAULO MED J 2024; 142:e2023161. [PMID: 38836818 DOI: 10.1590/1516-3180.2023.0161.r1.08022024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 02/08/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Evidence on the effect of one-anastomosis gastric bypass (OAGB) on renal function is limited. OBJECTIVE To compare the evolution of estimated renal function observed 1 year after OAGB and Roux-en-Y gastric bypass (RYGB) in individuals with obesity. DESIGN AND SETTING Observational, analytical, and retrospective cohort study. Tertiary-level university hospital. METHODS This study used a prospectively collected database of individuals who consecutively underwent bariatric surgery. Renal function was assessed by calculating the estimated glomerular filtration rate (eGFR), according to the Chronic Kidney Disease Epidemiology Collaboration. The one-year variation in the eGFR was compared between the procedures. RESULTS No significant differences in age, sex, obesity-associated conditions, or body mass index were observed among individuals who underwent either OAGB or RYGB. OAGB led to a significantly higher percentage of total (P = 0.007) and excess weight loss (P = 0.026). Both OAGB and RYGB led to significantly higher values of eGFR (103.9 ± 22 versus 116.1 ± 13.3; P = 0.007, and 102.4 ± 19 versus 113.2 ± 13.3; P < 0.001, respectively). The one-year variation in eGFR was 11 ± 16.2% after OAGB and 16.7 ± 26.3% after RYGB (P = 0.3). Younger age and lower baseline eGFR were independently associated with greater postoperative improvement in renal function (P < 0.001). CONCLUSION Compared with RYGB, OAGB led to an equivalent improvement in renal function 1 year after the procedure, along with greater weight loss.
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Affiliation(s)
- Victor Kenzo Ivano
- MD. Postgraduate Student, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Marcelo Hatto
- MD. Postgraduate Student, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Fernanda Teramoto
- MD. Medical Resident, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Paolla Ravida Alves de Macedo
- MD. Medical Resident, Department of Surgery School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Martinho Antonio Gestic
- MD, MSc. Assistant lecturer, Department of Surgery, School of Medical Sciences, Universidade State University of Campinas (UNICAMP), Campinas (SP), Brazil
| | - Murillo Pimentel Utrini
- MD. Assistant Lecturer, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Felipe David Mendonça Chaim
- MD, PhD. Assistant Lecturer, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Almino Cardoso Ramos
- MD, PhD. Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Francisco Callejas-Neto
- MD, MSc. Assistant Professor, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Elinton Adami Chaim
- MD, PhD. Full Professor, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Everton Cazzo
- MD, PhD. Associate Professor, Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
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Vaughns JD, McCullough-Roach R, Williams EF, Nadler EP. Child and Adolescent Bariatric Surgery in an Urban Tertiary Center: Special Anesthetic Considerations for Obesity. J Clin Pharmacol 2023; 63 Suppl 2:S103-S109. [PMID: 37942911 DOI: 10.1002/jcph.2372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/13/2023] [Indexed: 11/10/2023]
Abstract
Children and adolescents with obesity who present for weight loss surgery are a unique subset of patients. A thorough understanding of the perioperative needs of these individuals is essential to avoid deleterious complications. This review illustrates the necessity for specialized care, including the continued need of specified drug dosing and a systematic approach in the management of the pediatric bariatric patient.
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Affiliation(s)
- Janelle D Vaughns
- Divisions of Anesthesiology, Pain and Perioperative Medicine, and Clinical Pharmacology, Children's National Hospital, The George Washington University, Washington, DC, USA
| | | | - Elaine F Williams
- Division of Clinical Pharmacology, Children's National Hospital, The George Washington University, Washington, DC, USA
| | - Evan P Nadler
- Division of Surgery, Children's National Hospital, The George Washington University, Washington, DC, USA
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Pané A, Claro M, Molina-Andujar A, Olbeyra R, Romano-Andrioni B, Boswell L, Montagud-Marrahi E, Jiménez A, Ibarzabal A, Viaplana J, Ventura-Aguiar P, Amor AJ, Vidal J, Flores L, de Hollanda A. Bariatric Surgery Outcomes in Patients with Chronic Kidney Disease. J Clin Med 2023; 12:6095. [PMID: 37763037 PMCID: PMC10532233 DOI: 10.3390/jcm12186095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Obesity increases the risk of developing chronic kidney disease (CKD), which has a major negative impact on global health. Bariatric surgery (BS) has demonstrated a substantial improvement of obesity-related comorbidities and thus, it has emerged as a potential therapeutic tool in order to prevent end-stage renal disease. A limited number of publications to date have examined the beneficial effects and risks of BS in patients with non-advanced stages of CKD. We aimed to investigate the safety of BS in patients with CKD stages 3-4 (directly related or not to obesity) and both the metabolic/renal outcomes post-BS. A total of 57 individuals were included (n = 19 for CKD-group; n = 38 for patients with obesity, but normal eGFR [control-group]). Weight loss and obesity comorbidities resolution after BS were similar in both groups. Renal function (eGFR [CKD-EPI]) improved significantly at the 1-year follow-up: Δ10.2 (5.2-14.9) (p < 0.001) for CKD-group and Δ4.0 (-3.9-9.0) mL/min/1.73 m2 (p = 0.043) for controls. Although this improvement tended to decrease in the 5-year follow-up, eGFR remained above its basal value for the CKD-group. Noteworthy, eGFR also improved in those patients who presented CKD not directly attributed to obesity. For patients with CKD, BS appears to be safe and effective regarding weight loss and obesity comorbidities resolution, irrespective of the main cause of CKD (related or not to obesity).
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Affiliation(s)
- Adriana Pané
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain; (M.C.); (B.R.-A.); (A.J.); (A.J.A.); (J.V.)
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Maria Claro
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain; (M.C.); (B.R.-A.); (A.J.); (A.J.A.); (J.V.)
| | - Alicia Molina-Andujar
- Nephrology and Kidney Transplantation Department, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (A.M.-A.); (E.M.-M.)
- Endocrinology and Nutrition Department, Althaia Universitary Health Network, 08243 Manresa, Spain
| | - Romina Olbeyra
- Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS)—Fundació Clínic per a la Recerca Biomèdica (FCRB), 08036 Barcelona, Spain; (R.O.); (J.V.)
| | - Bárbara Romano-Andrioni
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain; (M.C.); (B.R.-A.); (A.J.); (A.J.A.); (J.V.)
- Nephrology and Kidney Transplantation Department, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (A.M.-A.); (E.M.-M.)
| | - Laura Boswell
- Endocrinology and Nutrition Department, Althaia Universitary Health Network, 08243 Manresa, Spain
| | - Enrique Montagud-Marrahi
- Nephrology and Kidney Transplantation Department, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (A.M.-A.); (E.M.-M.)
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Centre de recerca biomèdica Cellex (CRB CELLEX), Fundació Clinic, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Amanda Jiménez
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain; (M.C.); (B.R.-A.); (A.J.); (A.J.A.); (J.V.)
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS)—Fundació Clínic per a la Recerca Biomèdica (FCRB), 08036 Barcelona, Spain; (R.O.); (J.V.)
| | - Ainitze Ibarzabal
- Obesity Unit, Gastrointestinal Surgery Department, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Judith Viaplana
- Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS)—Fundació Clínic per a la Recerca Biomèdica (FCRB), 08036 Barcelona, Spain; (R.O.); (J.V.)
| | - Pedro Ventura-Aguiar
- Nephrology and Kidney Transplantation Department, Hospital Clinic de Barcelona, 08036 Barcelona, Spain; (A.M.-A.); (E.M.-M.)
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Centre de recerca biomèdica Cellex (CRB CELLEX), Fundació Clinic, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Antonio J. Amor
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain; (M.C.); (B.R.-A.); (A.J.); (A.J.A.); (J.V.)
| | - Josep Vidal
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain; (M.C.); (B.R.-A.); (A.J.); (A.J.A.); (J.V.)
- Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS)—Fundació Clínic per a la Recerca Biomèdica (FCRB), 08036 Barcelona, Spain; (R.O.); (J.V.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
| | - Lilliam Flores
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain; (M.C.); (B.R.-A.); (A.J.); (A.J.A.); (J.V.)
- Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS)—Fundació Clínic per a la Recerca Biomèdica (FCRB), 08036 Barcelona, Spain; (R.O.); (J.V.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
| | - Ana de Hollanda
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain; (M.C.); (B.R.-A.); (A.J.); (A.J.A.); (J.V.)
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS)—Fundació Clínic per a la Recerca Biomèdica (FCRB), 08036 Barcelona, Spain; (R.O.); (J.V.)
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Keramat SA, Alam K, Basri R, Siddika F, Siddiqui ZH, Okyere J, Seidu AA, Ahinkorah BO. Sleep duration, sleep quality and the risk of being obese: Evidence from the Australian panel survey. Sleep Med 2023; 109:56-64. [PMID: 37418828 DOI: 10.1016/j.sleep.2023.06.012] [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: 02/18/2023] [Revised: 05/27/2023] [Accepted: 06/11/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Sleep difficulty is an unmet public health concern affecting a vast proportion of the world's population. Poor sleep duration (short or long sleep length) and quality affect more than half of older people. Sleep difficulty is associated with negative health outcomes such as obesity and reduced longevity. We aimed to assess whether poor sleep duration and quality are significant risk factors for obesity in adults aged 15 and over in Australia by examining a nationally representative panel data. METHODS We used three waves (waves 13, 17, and 21) of the nationally representative Household, Income and Labour Dynamics in Australia (HILDA) survey data. The study applied generalized estimating equations (GEE) logistic regression model to assess the relationship between sleep duration and quality with obesity. RESULTS The study found that the odds of being obese was significantly higher amongst the study participants with poor sleep duration (adjusted odds ratio [aOR]: 1.24, 95% confidence interval [CI]: 1.16-1.32) and poor sleep quality (aOR: 1.29, 95% CI: 1.02-1.38) compared with their counterparts who had good sleep duration and quality, respectively. CONCLUSION Having short or long sleep at night and poor sleep quality are associated with an increased risk of obesity. Obesity poses a significant threat to the health of Australian adults. Enacting policies that raise public awareness of the significance of good sleep hygiene and encouraging healthy sleeping habits should be considered to address the alarming rise in the obesity rate.
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Affiliation(s)
- Syed Afroz Keramat
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Australia; School of Business, and Centre for Health Research, The University of Southern Queensland, Australia.
| | - Khorshed Alam
- School of Business, and Centre for Health Research, The University of Southern Queensland, Australia
| | - Rabeya Basri
- Department of Economics, Rajshahi University, Bangladesh
| | - Farzana Siddika
- Department of Mathematics and Natural Sciences, BRAC University, Dhaka, Bangladesh
| | - Zubayer Hassan Siddiqui
- Department of Business Administration, Bangladesh University of Professionals, Dhaka, Bangladesh
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- REMS Consult Limited, Sekondi-Takoradi, Western Region, Ghana; College of Public Health, Medical and Veterinary Sciences, James Cook University, Australia
| | - Bright Opoku Ahinkorah
- REMS Consult Limited, Sekondi-Takoradi, Western Region, Ghana; School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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5
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Kataoka H, Nitta K, Hoshino J. Glomerular hyperfiltration and hypertrophy: an evaluation of maximum values in pathological indicators to discriminate "diseased" from "normal". Front Med (Lausanne) 2023; 10:1179834. [PMID: 37521339 PMCID: PMC10372422 DOI: 10.3389/fmed.2023.1179834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/05/2023] [Indexed: 08/01/2023] Open
Abstract
The success of sodium-glucose cotransporter 2 inhibitors and bariatric surgery in patients with chronic kidney disease has highlighted the importance of glomerular hyperfiltration and hypertrophy in the progression of kidney disease. Sustained glomerular hyperfiltration and hypertrophy can lead to glomerular injury and progressive kidney damage. This article explores the relationship between obesity and chronic kidney disease, focusing on the roles of glomerular hyperfiltration and hypertrophy as hallmarks of obesity-related kidney disease. The pathological mechanisms underlying this association include adipose tissue inflammation, dyslipidemia, insulin resistance, chronic systemic inflammation, oxidative stress, and overactivation of the sympathetic nervous system, as well as the renin-angiotensin aldosterone system. This article explains how glomerular hyperfiltration results from increased renal blood flow and intraglomerular hypertension, inducing mechanical stress on the filtration barrier and post-filtration structures. Injured glomeruli increase in size before sclerosing and collapsing. Therefore, using extreme values, such as the maximal glomerular diameter, could improve the understanding of the data distribution and allow for better kidney failure predictions. This review provides important insights into the mechanisms underlying glomerular hyperfiltration and hypertrophy and highlights the need for further research using glomerular size, including maximum glomerular profile, calculated using needle biopsy specimens.
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Olszanecka-Glinianowicz M, Mazur A, Chudek J, Kos-Kudła B, Markuszewski L, Dudek D, Major P, Małczak P, Tarnowski W, Jaworski P, Tomiak E. Obesity in Adults: Position Statement of Polish Association for the Study on Obesity, Polish Association of Endocrinology, Polish Association of Cardiodiabetology, Polish Psychiatric Association, Section of Metabolic and Bariatric Surgery of the Association of Polish Surgeons, and the College of Family Physicians in Poland. Nutrients 2023; 15:nu15071641. [PMID: 37049479 PMCID: PMC10097178 DOI: 10.3390/nu15071641] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
Obesity in adults and its complications are among the most important problems of public health. The search was conducted by using PubMed/MEDLINE, Cochrane Library, Science Direct, MEDLINE, and EBSCO databases from January 2010 to December 2022 for English language meta-analyses, systematic reviews, randomized clinical trials, and observational studies from all over the world. Six main topics were defined in the joint consensus statement of the Polish Association for the Study on Obesity, the Polish Association of Endocrinology, the Polish Association of Cardio-diabetology, the Polish Psychiatric Association, the Section of Metabolic and Bariatric Surgery of the Society of Polish Surgeons, and the College of Family Physicians in Poland: (1) the definition, causes and diagnosis of obesity; (2) treatment of obesity; (3) treatment of main complications of obesity; (4) bariatric surgery and its limitations; (5) the role of primary care in diagnostics and treatment of obesity and barriers; and (6) recommendations for general practitioners, regional authorities and the Ministry of Health. This statement outlines the role of an individual and the adequate approach to the treatment of obesity: overcoming obstacles in the treatment of obesity by primary health care. The approach to the treatment of obesity in patients with its most common complications is also discussed. Attention was drawn to the importance of interdisciplinary cooperation and considering the needs of patients in increasing the long-term effectiveness of obesity management.
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Affiliation(s)
- Magdalena Olszanecka-Glinianowicz
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, Medical Faculty in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
- Correspondence:
| | - Artur Mazur
- Institute of Medical Sciences, Medical College of Rzeszow University, University of Rzeszów, 35-601 Rzeszow, Poland;
| | - Jerzy Chudek
- Department of Internal Diseases and Oncological Chemotherapy, Medical Faculty in Katowice, Medical University of Silesia, 40-027 Katowice, Poland
| | - Beata Kos-Kudła
- Department of Endocrinology and Neuroendocrine Tumors, Department of Pathophysiology and Endocrinology, Medical University of Silesia, 40-055 Katowice, Poland
| | - Leszek Markuszewski
- Faculty of Medical Sciences and Health Sciences, University of Humanities and Technology in Radom, 26-600 Radom, Poland
| | - Dominika Dudek
- Department of Psychiatry, Jagiellonian University Medical College, 31-008 Cracow, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, 31-008 Cracow, Poland
| | - Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, 31-008 Cracow, Poland
| | - Wiesław Tarnowski
- Department of General, Oncological and Bariatric Surgery, Centre of Postgraduate Medical Education, Orłowski Hospital, 00-416 Warsaw, Poland
| | - Paweł Jaworski
- Department of General, Oncological and Bariatric Surgery, Centre of Postgraduate Medical Education, Orłowski Hospital, 00-416 Warsaw, Poland
| | - Elżbieta Tomiak
- The College of Family Physicians in Poland, 00-209 Warsaw, Poland
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Colbran R, Nicol A, Mangan S, Sabat N, Pretorius F. Outcomes of the overweight and obese major trauma patient in the rural setting. Injury 2023; 54:1369-1373. [PMID: 36669945 DOI: 10.1016/j.injury.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/17/2022] [Accepted: 01/02/2023] [Indexed: 01/07/2023]
Abstract
PURPOSE Overweight and obese patients are more prevalent in rural and remote areas and are of major public health concern in Australia. We aimed to evaluate the mortality and morbidity of overweight and obese trauma patients in the rural Australian context. METHOD This was a retrospective cohort study on 207 major trauma patients (injury severity score [ISS] > 12) treated at the Mackay Base Hospital between 2018 and 2021. Data was extracted from the Mackay Base Hospital trauma database and hospital records. Outcomes were compared between body mass index (BMI) groups. RESULTS There were 164 males (79%) and 43 females (21%). The average BMI was 27.09 (standard deviation 5.46). 7 patients (3%) were in the underweight category (BMI < 18.5 kg/m2), 70 (34%) were of normal weight (BMI 18.5-24.9 kg/m2), 79 (38%) were overweight (BMI 25-29.9 kg/m2), and 51 (25%) were obese (BMI > 30 kg/m2). The majority of trauma was blunt (n = 203, 98%). Compared to patients with normal BMI, obese patients were significantly more likely to require intubation, intensive care unit (ICU) admission, and have a longer ICU stay. There were no significant differences in requirement for surgery, duration of surgery, hospital length of stay, ventilator time, or mortality (P > 0.05). However, subgroup analysis of the obese patient group showed an increased rate of complications (sepsis, acute kidney injury, fluid overload and pneumonia), longer ventilation times, hospital and ICU length of stay with increasing BMI in these patients. CONCLUSION The majority of trauma presentations in our regional community are in overweight or obese patients. Overweight and obese patients are more likely to require intubation and have a longer intensive care unit admission than normal weight counterparts. Amongst obese patients, those with BMI > 40 (obesity class 3) are at significantly increased risk of complications.
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Affiliation(s)
- Rachel Colbran
- Mackay Base Hospital, Mackay, Queensland, Australia; University of Queensland, Brisbane, Queensland, Australia.
| | - Alice Nicol
- Mackay Base Hospital, Mackay, Queensland, Australia
| | | | - Nestor Sabat
- Mackay Base Hospital, Mackay, Queensland, Australia; University of Queensland, Brisbane, Queensland, Australia
| | - Francois Pretorius
- Mackay Base Hospital, Mackay, Queensland, Australia; James Cook University, Townsville, Australia
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Kataoka H, Nitta K, Hoshino J. Visceral fat and attribute-based medicine in chronic kidney disease. Front Endocrinol (Lausanne) 2023; 14:1097596. [PMID: 36843595 PMCID: PMC9947142 DOI: 10.3389/fendo.2023.1097596] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/13/2023] [Indexed: 02/11/2023] Open
Abstract
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.
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Comparison of Dose Adjustment Strategies for Obesity in High-dose Cyclophosphamide Among Adult Hematopoietic Cell Transplantation Recipients: Pharmacokinetic Analysis. Transplant Cell Ther 2022; 28:845.e1-845.e8. [PMID: 36167308 DOI: 10.1016/j.jtct.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 09/06/2022] [Accepted: 09/20/2022] [Indexed: 12/24/2022]
Abstract
Cyclophosphamide (CY) is an alkylating agent widely used in the field of oncology and hematopoietic cell transplantation (HCT). It is recommended to use an adjusted body weight with an adjustment factor of 0.25 (ABW25) for dosing of CY in obese patients undergoing HCT. However, evidence based on the pharmacokinetics (PK) of CY to support this recommendation is lacking. We aimed to identify a dosing strategy of CY that achieves equivalent exposures among obese and nonobese patients. The present study is a secondary analysis of a previously conducted observational PK study of phosphoramide mustard (PM), the final cytotoxic metabolite of CY. Data were collected from 85 adults with hematologic malignancy who received a single infusion of CY 50 mg/kg, fludarabine, ± anti-thymocyte globulin, and a single fraction of total body irradiation as HCT conditioning therapy. A previously developed population PK model in these patients was used for simulations. Using individualized PK parameters from that analysis, simulations were performed to assess cumulative exposures of PM (i.e., area-under-the-curve [AUC]) resulting from 8 different dosing strategies according to various measures of body size: (1) "mg/kg" by total body weight (TBW); (2) "mg/kg" by ideal body weight (IBW); (3) "mg/kg" by fat free mass; (4) "mg/m2" by body surface area (BSA); (5) "mg/kg" by TBW combined with ABW25 (TBW-ABW25); (6) "mg/kg" by IBW combined with ABW25 (IBW-ABW25); (7) "mg/kg" by TBW combined with ABW by adjustment factor of 0.50 (TBW-ABW50); and (8) "mg" by fixed-dose. We defined equivalent exposure as the effect of obesity on PM AUC within ±20% from the PM AUC in the nonobese group, where obesity is defined based on TBW/IBW ratio (i.e., nonobese, <1.2; mildly obese, 1.2-1.5; and moderately/severely obese, >1.5). Primary and secondary outcomes were PM AUC0-8hours and PM AUC0-infinity, respectively. In the 85 patients, with the median age of 63 years (range 21-75), 46% were classified as mildly and 25% were moderately/severely obese based on the TBW/IBW ratio. Negative correlations (i.e., higher the extent of obesity, lower the PM AUC) were shown when dosing simulations were based on IBW, TBW-ABW25, and fixed dosing (P < .05). Positive correlations were shown when dosing was simulated by TBW (P < .05). None of the 8 dosing strategies attained equivalent PM AUC0-8hours between patients with versus without obesity, whereas dosing by BSA and TBW-ABW50 attained equivalent PM AUC0-infinity (P < .05). Our study predicted that the recommended ABW25 dose adjustment may result in lower exposure of CY therapy in obese patients than in nonobese. A CY dosing strategy that would result in similar PM concentrations between obese and nonobese was not identified for early exposure (i.e., PM AUC0-8hours). The data suggest though that CY dosing based on "mg/m2" by BSA or "mg/kg" by TBW-ABW50 would result in similar total exposure (i.e., PM AUC0-infinity) and may minimize exposure differences in obese and nonobese patients.
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10
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Bariatric Surgery Outcomes in Patients with Kidney Transplantation. J Clin Med 2022; 11:jcm11206030. [PMID: 36294351 PMCID: PMC9604744 DOI: 10.3390/jcm11206030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/03/2022] [Accepted: 10/11/2022] [Indexed: 11/17/2022] Open
Abstract
Obesity and kidney transplantation (KTx) are closely related. Obesity increases the risk of chronic kidney disease and can be a relative contraindication for KTx. Besides, KTx recipients are predisposed to obesity and its comorbidities. Consequently, bariatric surgery (BS) emerges as a powerful therapeutic tool either before or after KTx. Since evidence regarding the best approach is still scarce, we aimed to describe renal and metabolic outcomes in a single centre with more than 15-year experience in both surgeries. Methods: A retrospective study including patients who had received a KTx either before or after BS. Usual metabolic and renal outcomes, but also new variables (as renal graft dysfunction) were collected for a minimum follow-up of 1-year post-BS. Results: A total of 11 patients were included: n = 6 (BS-post-KTx) and n = 5 (BS-pre-KTx). One patient was assessed in both groups. No differences in the main outcomes were identified, but BS-post-KTx group tended to gain more weight during the follow-up. The incidence of renal graft dysfunction was comparable (4/6 for BS-post-KTx, 3/5 for BS-pre-KTx) between groups. Conclusions: BS in patients with KTx appears to be safe and effective attending to metabolic and renal outcomes. These results seem irrespective of the time course, except for weight regain, which appears to be a common pattern in the BS-post-KTx group.
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11
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Novel Insights in the Physiopathology and Management of Obesity-Related Kidney Disease. Nutrients 2022; 14:nu14193937. [PMID: 36235590 PMCID: PMC9572176 DOI: 10.3390/nu14193937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 11/30/2022] Open
Abstract
Obesity is recognized as an independent risk factor for the development of kidney disease, which has led to the designation of obesity-related glomerulopathy (ORG). Common renal features observed in this condition include glomerular hypertrophy, glomerulosclerosis, haemodynamic changes and glomerular filtration barrier defects. Additionally, and although less studied, obesity-related kidney disease also involves alterations in renal tubules, including tubule hypertrophy, lipid deposition and tubulointerstitial fibrosis. Although not completely understood, the harmful effects of obesity on the kidney may be mediated by different mechanisms, with alterations in adipose tissue probably playing an important role. An increase in visceral adipose tissue has classically been associated with the development of kidney damage, however, recent studies point to adipose tissue surrounding the kidney, and specifically to the fat within the renal sinus, as potentially involved in the development of ORG. In addition, new strategies for the treatment of patients with obesity-related kidney disease are focusing on the management of obesity. In this regard, some non-invasive options, such as glucagon-like peptide-1 (GLP-1) receptor agonists or sodium–glucose cotransporter-2 (SGLT2) inhibitors, are being considered for application in the clinic, not only for patients with diabetic kidney disease but as a novel pharmacological strategy for patients with ORG. In addition, bariatric surgery stands as one of the most effective options, not only for weight loss but also for the improvement of kidney outcomes in obese patients with chronic kidney disease.
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12
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Valdez Imbert R, Hti Lar Seng NS, Stokes MB, Jim B. Obesity-related glomerulopathy in the presence of APOL1 risk alleles. BMJ Case Rep 2022; 15:e249624. [PMID: 35985743 PMCID: PMC9396144 DOI: 10.1136/bcr-2022-249624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Nephropathic apolipoprotein L1 (APOL1) risk alleles (G1/G2) have been associated with focal segmental glomerulosclerosis, HIV-associated nephropathy, Systemic lupus erythematosus (SLE)-associated collapsing glomerulopathy and other glomerulonephritides. These alleles confer protection from Trypanosoma brucei infections which are enriched in sub-Saharan African populations. We present a young woman with obesity, hypertension, subnephrotic range proteinuria who was found to have obesity-related glomerulopathy on kidney biopsy while harbouring two high-risk APOL1 alleles (G1/G2). Given the potential effects on lipid metabolism and their association with obesity, the presence of APOL1 risk alleles may impact cardiovascular health in addition to renal disease in these patients.
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Affiliation(s)
- Ronald Valdez Imbert
- Department of Medicine, Jacobi Medical Center at Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nang San Hti Lar Seng
- Department of Medicine, Jacobi Medical Center at Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michael B Stokes
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Belinda Jim
- Department of Medicine, Jacobi Medical Center at Albert Einstein College of Medicine, Bronx, New York, USA
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13
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Czaja-Stolc S, Potrykus M, Stankiewicz M, Kaska Ł, Małgorzewicz S. Pro-Inflammatory Profile of Adipokines in Obesity Contributes to Pathogenesis, Nutritional Disorders, and Cardiovascular Risk in Chronic Kidney Disease. Nutrients 2022; 14:nu14071457. [PMID: 35406070 PMCID: PMC9002635 DOI: 10.3390/nu14071457] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 01/27/2023] Open
Abstract
Obesity is a disease which leads to the development of many other disorders. Excessive accumulation of lipids in adipose tissue (AT) leads to metabolic changes, including hypertrophy of adipocytes, macrophage migration, changes in the composition of immune cells, and impaired secretion of adipokines. Adipokines are cytokines produced by AT and greatly influence human health. Obesity and the pro-inflammatory profile of adipokines lead to the development of chronic kidney disease (CKD) through different mechanisms. In obesity and adipokine profile, there are gender differences that characterize the male gender as more susceptible to metabolic disorders accompanying obesity, including impaired renal function. The relationship between impaired adipokine secretion and renal disease is two-sided. In the developed CKD, the concentration of adipokines in the serum is additionally disturbed due to their insufficient excretion by the excretory system caused by renal pathology. Increased levels of adipokines affect the nutritional status and cardiovascular risk (CVR) of patients with CKD. This article aims to systematize the current knowledge on the influence of obesity, AT, and adipokine secretion disorders on the pathogenesis of CKD and their influence on nutritional status and CVR in patients with CKD.
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Affiliation(s)
- Sylwia Czaja-Stolc
- Department of Clinical Nutrition, Medical University of Gdansk, 80-211 Gdańsk, Poland; (M.S.); (S.M.)
- Correspondence: ; Tel.: +48-(58)-349-27-24
| | - Marta Potrykus
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, 80-211 Gdańsk, Poland; (M.P.); (Ł.K.)
| | - Marta Stankiewicz
- Department of Clinical Nutrition, Medical University of Gdansk, 80-211 Gdańsk, Poland; (M.S.); (S.M.)
| | - Łukasz Kaska
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, 80-211 Gdańsk, Poland; (M.P.); (Ł.K.)
| | - Sylwia Małgorzewicz
- Department of Clinical Nutrition, Medical University of Gdansk, 80-211 Gdańsk, Poland; (M.S.); (S.M.)
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14
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Kidney Damage Caused by Obesity and Its Feasible Treatment Drugs. Int J Mol Sci 2022; 23:ijms23020747. [PMID: 35054932 PMCID: PMC8775419 DOI: 10.3390/ijms23020747] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/05/2022] [Accepted: 01/08/2022] [Indexed: 02/07/2023] Open
Abstract
The rapid growth of obesity worldwide has made it a major health problem, while the dramatic increase in the prevalence of obesity has had a significant impact on the magnitude of chronic kidney disease (CKD), especially in developing countries. A vast amount of researchers have reported a strong relationship between obesity and chronic kidney disease, and obesity can serve as an independent risk factor for kidney disease. The histological changes of kidneys in obesity-induced renal injury include glomerular or tubular hypertrophy, focal segmental glomerulosclerosis or bulbous sclerosis. Furthermore, inflammation, renal hemodynamic changes, insulin resistance and lipid metabolism disorders are all involved in the development and progression of obesity-induced nephropathy. However, there is no targeted treatment for obesity-related kidney disease. In this review, RAS inhibitors, SGLT2 inhibitors and melatonin would be presented to treat obesity-induced kidney injury. Furthermore, we concluded that melatonin can protect the kidney damage caused by obesity by inhibiting inflammation and oxidative stress, revealing its therapeutic potential.
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15
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Kotsis V, Martinez F, Trakatelli C, Redon J. Impact of Obesity in Kidney Diseases. Nutrients 2021; 13:nu13124482. [PMID: 34960033 PMCID: PMC8703549 DOI: 10.3390/nu13124482] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 01/14/2023] Open
Abstract
The clinical consequences of obesity on the kidneys, with or without metabolic abnormalities, involve both renal function and structures. The mechanisms linking obesity and renal damage are well understood, including several effector mechanisms with interconnected pathways. Higher prevalence of urinary albumin excretion, sub-nephrotic syndrome, nephrolithiasis, increased risk of developing CKD, and progression to ESKD have been identified as being associated with obesity and having a relevant clinical impact. Moreover, renal replacement therapy and kidney transplantation are also influenced by obesity. Losing weight is key in limiting the impact that obesity produces on the kidneys by reducing albuminuria/proteinuria, declining rate of eGFR deterioration, delaying the development of CKD and ESKD, and improving the outcome of a renal transplant. Weight reduction may also contribute to appropriate control of cardiometabolic risk factors such as hypertension, metabolic syndrome, diabetes, and dyslipidemia which may be protective not only in renal damage but also cardiovascular disease. Lifestyle changes, some drugs, and bariatric surgery have demonstrated the benefits.
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Affiliation(s)
- Vasilios Kotsis
- 3rd Department of Internal Medicine, Hypertension-24h ABPM ESH Center of Excellence, Papageorgiou Hospital, Aristotle University of Thessaloniki, 564 29 Pavlos Melas, Greece; (V.K.); (C.T.)
| | - Fernando Martinez
- Internal Medicine Hospital Clínico de Valencia, 46010 Valencia, Spain;
| | - Christina Trakatelli
- 3rd Department of Internal Medicine, Hypertension-24h ABPM ESH Center of Excellence, Papageorgiou Hospital, Aristotle University of Thessaloniki, 564 29 Pavlos Melas, Greece; (V.K.); (C.T.)
| | - Josep Redon
- Internal Medicine Hospital Clínico de Valencia, 46010 Valencia, Spain;
- Cardiovascular and Renal Research Group, INCLIVA Research Institute, University of Valencia, 46010 Valencia, Spain
- CIBERObn Carlos III Institute, 28029 Madrid, Spain
- Correspondence:
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16
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Adrian T, Sørensen IMH, Knop FK, Bro S, Ballegaard ELF, Nordestgaard BG, Fuchs A, Kofoed KF, Kühl JT, Sigvardsen PE, Hornum M, Feldt-Rasmussen B. Prevalence of non-alcoholic fatty liver disease in patients with chronic kidney disease: a case-control study. Nephrol Dial Transplant 2021; 37:1927-1934. [PMID: 34505899 DOI: 10.1093/ndt/gfab266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease and represents a wide spectrum ranging from mild steatosis over non-alcoholic steatohepatitis with and without fibrosis to overt cirrhosis. Patients with NAFLD have a high risk of developing cardiovascular disease and chronic kidney disease (CKD). So far, there is scarce evidence of the prevalence of NAFLD among patients with CKD. We investigated the prevalence of moderate-to-severe hepatic steatosis graded according to the definition of NAFLD in a cohort of patients with CKD. METHODS Hepatic liver fat content was evaluated by computed tomography (CT) scan in 291 patients from the Copenhagen Chronic Kidney Disease Cohort Study and in 866 age- and sex-matched individuals with normal kidney function from the Copenhagen General Population Study. Liver attenuation density <48 Hounsfield units was used as cut-off value for moderate-to-severe hepatic steatosis. RESULTS The prevalence of moderate-to-severe hepatic steatosis was 7.9% and 10.7% (P = 0.177) among patients with CKD and controls, respectively. No association between liver fat content and CKD stage was found. In the pooled data set from both cohorts, adjusted odds ratios for moderate-to-severe hepatic steatosis among persons with diabetes, overweight and obesity amounted to 3.1 (95% confidence interval (CI) 1.6-5.9), 14.8 (95% CI 4.6-47.9) and 42.0 (95% CI 12.9-136.6), respectively. CONCLUSIONS In a cohort of 291 patients with CKD, kidney function was not associated with the prevalence of moderate-to-severe hepatic steatosis as assessed by CT scan.
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Affiliation(s)
- Therese Adrian
- Department of Nephrology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Ida M H Sørensen
- Department of Nephrology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Filip K Knop
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Center for Clinical Metabolic Research, Copenhagen University Hospital-Gentofte Hospital, Hellerup, Denmark.,Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Susanne Bro
- Department of Nephrology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Ellen L F Ballegaard
- Department of Nephrology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Department of Clinical Biochemistry, and the Copenhagen General Population Study, Copenhagen University Hospital-Herlev and Gentofte Hospital, Herlev, Denmark.,The Copenhagen City Heart Study, Copenhagen University Hospital-Frederiksberg Hospital, Frederiksberg, Denmark
| | - Andreas Fuchs
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Radiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Klaus F Kofoed
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Radiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Jørgen T Kühl
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Radiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Per E Sigvardsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Radiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Mads Hornum
- Department of Nephrology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Bo Feldt-Rasmussen
- Department of Nephrology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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17
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Morales E, Porrini E, Martin-Taboada M, Luis-Lima S, Vila-Bedmar R, González de Pablos I, Gómez P, Rodríguez E, Torres L, Lanzón B, Rodríguez AE, Maíz M, Medina-Gómez G, Praga M. Renoprotective role of bariatric surgery in patients with established chronic kidney disease. Clin Kidney J 2021; 14:2037-2046. [PMID: 34476090 PMCID: PMC8406062 DOI: 10.1093/ckj/sfaa266] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/23/2020] [Indexed: 12/16/2022] Open
Abstract
Background Bariatric surgery (BS) has been postulated as the most effective measure for weight reduction. Weight loss improves metabolic parameters and exerts changes in renal function that lead to the amelioration of absolute or relative glomerular hyperfiltration, a condition that may be renoprotective in the long term. However, few studies have demonstrated the influence of BS in patients with severe obesity and chronic kidney disease (CKD). Our objective was to analyse the evolution of renal function, adipose tissue–derived molecules and inflammatory parameters in patients with CKD after BS. Methods This is an observational and prospective study. Thirty patients were screened and 12 were included between January 2016 and January 2018 with a 24-month follow-up. Glomerular filtration rate (GFR) was determined by plasma iohexol clearance. Adipokines, cytokines, circulating hormones and fibrotic parameters were evaluated before and 12 months after BS using the Bioplex system. Results The mean age was 50.6 years and 58.3% were males. Seven patients had a body mass index >40 kg/m2 and 66.7% were diabetic. Twenty-four months following BS there was a significant decrease in body weight (36.4%). Proteinuria decreased by 63.7 ± 28.2%. Measured GFR significantly diminished from before surgery to Month 24 after surgery (94 ± 44 to 79 ± 44 mL/min, P = 0.03). There was a significant decrease in adipocyte-derived molecules (leptin and vifastin) as well as in pro-inflammatory cytokines [interleukin (IL)-1β, tumour necrosis factor α, IL-6 and monocyte chemoattractant protein-1] and other circulating factors (vascular endothelial growth factor and transforming growth factor β isoforms). Conclusions BS is an effective option to prevent kidney damage in obese subjects with CKD due to the improvement of glomerular hyperfiltration, adipocyte cytokines metabolic and inflammatory parameters.
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Affiliation(s)
- Enrique Morales
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain.,Investigation Institute of University Hospital, 12 de Octubre , Madrid, Spain
| | - Esteban Porrini
- Faculty of Medicine, Instituto de Tecnologías Biomédicas, University of La Laguna, Laguna, Spain
| | - Marina Martin-Taboada
- Depatment Basic Sciences of Health, Faculty of Sciences of Health, Universidad Rey Juan Carlos, Madrid, Spain
| | - Sergio Luis-Lima
- Department of Nephrology and Hypertension, IIS-Fundación Jimenez Díaz, Madrid, Spain
| | - Rocío Vila-Bedmar
- Depatment Basic Sciences of Health, Faculty of Sciences of Health, Universidad Rey Juan Carlos, Madrid, Spain
| | | | - Pilar Gómez
- Department of Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Elías Rodríguez
- Department of Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Lucia Torres
- Depatment Basic Sciences of Health, Faculty of Sciences of Health, Universidad Rey Juan Carlos, Madrid, Spain
| | - Borja Lanzón
- Depatment Basic Sciences of Health, Faculty of Sciences of Health, Universidad Rey Juan Carlos, Madrid, Spain
| | - Ana Elena Rodríguez
- Fundación General de la ULL, Instituto de Tecnologias Biomédicas, Madrid, Spain
| | - María Maíz
- Department of Endocrinology, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Gema Medina-Gómez
- Depatment Basic Sciences of Health, Faculty of Sciences of Health, Universidad Rey Juan Carlos, Madrid, Spain
| | - Manuel Praga
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain.,Investigation Institute of University Hospital, 12 de Octubre , Madrid, Spain
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18
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Differences between Obese and Non-Obese Children and Adolescents Regarding Their Oral Status and Blood Markers of Kidney Diseases. J Clin Med 2021; 10:jcm10163723. [PMID: 34442019 PMCID: PMC8397190 DOI: 10.3390/jcm10163723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/11/2021] [Accepted: 08/17/2021] [Indexed: 01/05/2023] Open
Abstract
(1) Background: A rarely discussed effect of obesity-related glomerulopathy (ORG) may slowly lead to irreversible glomerular damage and the development of chronic kidney disease. These patients need to undertake medical care, but whether they should be included in intensive oral care is still not mandatory. The study aimed to assess a relationship between renal, metabolic, and oral health indicators among pediatric patients affected by simple obesity. (2) Methods: 45 children and adolescents with simple obesity hospitalized (BMI 34.1 ± 4.8 kg/m2, age 15.4 ± 2.3) and compared with 41 aged-matched healthy controls (BMI 16.4 ± 2.4 kg/m2, age 15.4 ± 2.7). Echocardiography, 24-h ambulatory blood pressure monitoring, ultrasound exam with Doppler, and laboratory tests including kidney and metabolic markers were performed. Oral status was examined regarding the occurrence of carious lesions using decay missing filling teeth (DMFT), gingivitis as bleeding on probing (BOP), and bacterial colonization as plaque control record (PCR). (3) Results: The strongest correlation was revealed between BMI and concentration of uric acid, cystatin C, GFR estimated by the Filler formula (r = 0.74; r = 0.48; r = -0.52), and between oral variables such as PCR and BOP (r = 0.54; r = 0.58). Children and adolescents with obesity demonstrated untreated dental caries, less efficient in plaque control and gingivitis. (4) Conclusions: No specific relation to markers of kidney disease were found; however, more frequent gingivitis/bacterial colonization and significant differences in oral status between obese and non-obese patients were revealed. Susceptibility to inflammation may be conducive to developing metabolic syndrome and kidney damage in the form of obesity-related glomerulopathy and contribute to future dental caries. Uric acid seems to indicate metabolic syndrome and cardiovascular complications (LVMI > 95 percentiles). Cystatin C and uric acid might aspire to be early markers of kidney damage leading to obesity-related glomerulopathy.
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Zhang T, Wang Y, Zhang X, Wang W, Zhao G. The Impact of Bariatric Surgery on Renal Function: a Retrospective Analysis of Short-Term Outcomes. Obes Surg 2021; 31:3476-3482. [PMID: 34061302 DOI: 10.1007/s11695-021-05366-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Obesity and diabetes mellitus are now leading causes of chronic kidney disease. Our study investigated the effects of bariatric surgery on estimated glomerular filtration (eGFR) and urinary microalbumin/creatinine ratio (ACR) in morbidly obese patients. MATERIALS AND METHODS The clinical materials for patients who underwent bariatric surgery were retrospectively analyzed with a 6-month follow-up period between January 1, 2018, and June 1, 2020. The eGFR (ml/min) was calculated using the Cockcroft-Gault formula equation. The urinary ACR was measured during the follow-up. Body mass index (BMI, kg/m2), percent weight loss (%WL), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were recorded during the follow-up. RESULTS Sixty-one patients who underwent bariatric surgery-laparoscopic Roux-en-Y gastric bypass (LRYGB; n = 22) and laparoscopic sleeve gastrectomy (LSG; n = 39)-were included in this study. The eGFR of both groups decreased at the follow-up outpatient visits (p < 0.001), although eGFR did not differ between the two groups. Unexpectedly, the ACR increased in the first month after LSG (p < 0.01) but decreased with a descending trend with no significant difference (p > 0.05) throughout the remaining follow-up period. Interestingly, ACR showed a descending trend with no significant difference during the follow-up in the LRYGB group (p > 0.05). The SBP and DBP decreased after bariatric surgery, with no significant difference between the two groups (p > 0.05). CONCLUSION Bariatric surgery is associated with improvements in postoperative renal function 6 months following surgery. The different alterations in ACR following LSG and LRYGB procedures demonstrate the underlying mechanism.
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Affiliation(s)
- Taotao Zhang
- Department of General Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang City, 110032, Liaoning Province, China.,The Second Gastric & Intestinal Department, Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian City, 116033, Liaoning Province, China
| | - Yong Wang
- Department of General Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang City, 110032, Liaoning Province, China.
| | - Xiangwen Zhang
- The Second Gastric & Intestinal Department, Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian City, 116033, Liaoning Province, China
| | - Wendi Wang
- The Fourth Obstetrics Ward, Dalian Maternal and Childcare Health Hospital Affiliated of Dalian Medical University, Dalian City, 116033, Liaoning Province, China
| | - Guohua Zhao
- The Second Gastric & Intestinal Department, Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian City, 116033, Liaoning Province, China
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20
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Aubert L, Sandino J, Gutiérrez-Solís E, García-Martín F, Segura J, Porrini E, Morales E. Role of non-alcoholic fatty liver disease in the evolution of renal function in patients with diabetes mellitus. Nephrol Dial Transplant 2021; 37:1125-1131. [PMID: 33983444 DOI: 10.1093/ndt/gfab176] [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: 02/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Increasing prevalence in type 2 diabetes mellitus (T2DM) have influenced in an increasing prevalence of chronic kidney disease (CKD). Little is known about the influence of non-alcoholic fatty liver disease (NAFLD) on progression of CKD. The aim of this study was to analyse the role of NAFLD and its severity in the progression of renal function in patients with T2DM. METHODS Retrospective and observational study, including patients with T2DM and estimated glomerular filtration rate (eGFR) >30 ml/min/1,73m2. NAFLD was defined with presence of compatible ultrasonography and/or presence of fibrosis using NAFLD score. Patients were classified in three groups according to the NAFLD score; group 1 <-1.85, group 2 -1.85 to 0.18, and group 3 > 0.18. RESULTS A total of 102 patients were included (67.6% males, median age 59 [53-64] years), with median time of T2DM evolution was 70 [39-131] months. Group 3 had lower eGFR (84.8 ± 40.4 vs 71.4 ± 30.6 ml/min/1.73m2; p = 0.03) and higher proteinuria at baseline (0.56 ± 0.77 vs 1.59 ± 2.70 g/24h; p = 0.05). After a follow-up time of 75.8 ± 23.9 months, group 3 had a significant decrease in eGFR (66.6 ± 33.3 vs 36.8 ± 23.1 ml/min/1.73m2; p = <0.01), and higher risk of CKD progression (OR 7.50; CI 95% 2.76-20.35; p = <0.001) defined as decrease in > 50% eGFR. CONCLUSIONS The presence of NAFLD with high-risk fibrosis confers higher risk of CKD progression in patients with T2DM. Therefore, NAFLD should be a risk factor evaluated in these patients to optimise treatment.
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Affiliation(s)
- Lucía Aubert
- Department of Nephrology, University Hospital "12 de Octubre", Madrid, Spain
| | - Justo Sandino
- Department of Nephrology, University Hospital "12 de Octubre", Madrid, Spain
| | | | - Florencio García-Martín
- Department of Nephrology, University Hospital "12 de Octubre", Madrid, Spain.,Complutense University, Department of Medicine, Madrid, Spain
| | - Julián Segura
- Department of Nephrology, University Hospital "12 de Octubre", Madrid, Spain.,Research Institute of University Hospital "12 de Octubre" (i + 12), Madrid, Spain
| | - Esteban Porrini
- University of La Laguna, Faculty of Medicine, Instituto de Tecnologías Biomédicas (ITB), Tenerife, Spain
| | - Enrique Morales
- Department of Nephrology, University Hospital "12 de Octubre", Madrid, Spain.,Research Institute of University Hospital "12 de Octubre" (i + 12), Madrid, Spain.,Complutense University, Department of Medicine, Madrid, Spain
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21
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Takata T, Isomoto H. Pleiotropic Effects of Sodium-Glucose Cotransporter-2 Inhibitors: Renoprotective Mechanisms beyond Glycemic Control. Int J Mol Sci 2021; 22:ijms22094374. [PMID: 33922132 PMCID: PMC8122753 DOI: 10.3390/ijms22094374] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 04/14/2021] [Accepted: 04/20/2021] [Indexed: 12/30/2022] Open
Abstract
Diabetes mellitus is a major cause of chronic kidney disease and end-stage renal disease. However, the management of chronic kidney disease, particularly diabetes, requires vast improvements. Recently, sodium-glucose cotransporter-2 (SGLT2) inhibitors, originally developed for the treatment of diabetes, have been shown to protect against kidney injury via glycemic control, as well as various other mechanisms, including blood pressure and hemodynamic regulation, protection from lipotoxicity, and uric acid control. As such, regulation of these mechanisms is recommended as an effective multidisciplinary approach for the treatment of diabetic patients with kidney disease. Thus, SGLT2 inhibitors are expected to become key drugs for treating diabetic kidney disease. This review summarizes the recent clinical evidence pertaining to SGLT2 inhibitors as well as the mechanisms underlying their renoprotective effects. Hence, the information contained herein will advance the current understanding regarding the pleiotropic effects of SGLT2 inhibitors, while promoting future research in the field.
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22
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Torguet Escuder P. [Obesity, chronic kidney disease and cardiovascular risk]. HIPERTENSION Y RIESGO VASCULAR 2021; 38:53-55. [PMID: 33752844 DOI: 10.1016/j.hipert.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/09/2021] [Accepted: 03/09/2021] [Indexed: 11/25/2022]
Affiliation(s)
- P Torguet Escuder
- Servicio de Nefrologia, Hospital Universitario Dr J. Trueta, Girona, España.
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23
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Grigoraș A, Balan RA, Căruntu ID, Giușcă SE, Lozneanu L, Avadanei RE, Rusu A, Riscanu LA, Amalinei C. Perirenal Adipose Tissue-Current Knowledge and Future Opportunities. J Clin Med 2021; 10:1291. [PMID: 33800984 PMCID: PMC8004049 DOI: 10.3390/jcm10061291] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 12/11/2022] Open
Abstract
The perirenal adipose tissue (PRAT), a component of visceral adipose tissue, has been recently recognized as an important factor that contributes to the maintenance of the cardiovascular system and kidney homeostasis. PRAT is a complex microenvironment consisting of a mixture of white adipocytes and dormant and active brown adipocytes, associated with predipocytes, sympathetic nerve endings, vascular structures, and different types of inflammatory cells. In this review, we summarize the current knowledge about PRAT and discuss its role as a major contributing factor in the pathogenesis of hypertension, obesity, chronic renal diseases, and involvement in tumor progression. The new perspectives of PRAT as an endocrine organ and recent knowledge regarding the possible activation of dormant brown adipocytes are nowadays considered as new areas of research in obesity, in close correlation with renal and cardiovascular pathology. Supplementary PRAT complex intervention in tumor progression may reveal new pathways involved in carcinogenesis and, implicitly, may identify additional targets for tailored cancer therapy.
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Affiliation(s)
- Adriana Grigoraș
- Department of Morphofunctional Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, Iasi 700115, Romania; (R.A.B.); (I.-D.C.); (S.E.G.); (L.L.); (R.E.A.); (A.R.); (L.A.R.)
| | | | | | | | | | | | | | | | - Cornelia Amalinei
- Department of Morphofunctional Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, Iasi 700115, Romania; (R.A.B.); (I.-D.C.); (S.E.G.); (L.L.); (R.E.A.); (A.R.); (L.A.R.)
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24
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Sandino J, Luzardo L, Morales E, Praga M. Which Patients with Obesity Are at Risk for Renal Disease? Nephron Clin Pract 2021; 145:595-603. [PMID: 33677441 DOI: 10.1159/000513868] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/16/2020] [Indexed: 11/19/2022] Open
Abstract
Obesity-related glomerulopathy (ORG) is an increasingly recognized cause of end-stage kidney disease. The most common clinical presentation is a slowly increasing nonnephrotic proteinuria that is followed by a progressive decline of kidney function. Key histological findings are glomerulomegaly and lesions of focal and segmental glomerulosclerosis. A central pathogenic mechanism is the increased sodium reabsorption by proximal tubules that typically accompanies obesity. This causes a decrease in the offer of sodium to the macula densa in the distal nephron, which results in a vasodilation of afferent glomerular arterioles and glomerular hyperfiltration. From a clinical point of view, it is essential to differentiate focal segmental glomerulosclerosis secondary to obesity from primary glomerular processes, which requires a careful differential diagnosis. Diet-induced weight loss, bariatric surgery, and renin-angiotensin blockers are the fundamental therapeutic measures in ORG. The recently developed sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 agonist represent a significant advance in renal protection and will probably improve clinical kidney outcomes in ORG.
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Affiliation(s)
- Justo Sandino
- Department of Nephrology, University Hospital "12 de Octubre", Madrid, Spain
| | - Leonella Luzardo
- Nephrology Center, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Enrique Morales
- Department of Nephrology, University Hospital "12 de Octubre", Madrid, Spain, .,Research Institute of University Hospital "12 de Octubre" (imas12), Madrid, Spain, .,Department of Medicine, Complutense University of Madrid, Madrid, Spain,
| | - Manuel Praga
- Department of Nephrology, University Hospital "12 de Octubre", Madrid, Spain.,Research Institute of University Hospital "12 de Octubre" (imas12), Madrid, Spain.,Department of Medicine, Complutense University of Madrid, Madrid, Spain
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25
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Sivam S, Yee BJ, Chadban SJ, Piper AJ, Hanly PJ, Wang D, Wong KK, Grunstein RR. Prevalence of chronic kidney disease in obesity hypoventilation syndrome and obstructive sleep apnoea with severe obesity. Sleep Med 2020; 74:73-77. [DOI: 10.1016/j.sleep.2020.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 01/28/2023]
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26
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Shields CA, Poudel B, McPherson KC, Brown AK, Ekperikpe US, Browning E, Sutton L, Cornelius DC, Williams JM. Treatment With Gemfibrozil Prevents the Progression of Chronic Kidney Disease in Obese Dahl Salt-Sensitive Rats. Front Physiol 2020; 11:566403. [PMID: 33071820 PMCID: PMC7533555 DOI: 10.3389/fphys.2020.566403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/27/2020] [Indexed: 11/24/2022] Open
Abstract
Recently, we reported that Dahl salt-sensitive leptin receptor mutant (SSLepRmutant) rats exhibit dyslipidemia and renal lipid accumulation independent of hyperglycemia that progresses to chronic kidney disease (CKD). Therefore, in the current study, we examined the effects of gemfibrozil, a lipid-lowering drug (200 mg/kg/day, orally), on the progression of renal injury in SS and SSLepRmutant rats for 4 weeks starting at 12 weeks of age. Plasma triglyceride levels were markedly elevated in the SSLepRmutant strain compared to SS rats (1193 ± 243 and 98 ± 16 mg/day, respectively). Gemfibrozil treatment only reduced plasma triglycerides in the SSLepRmutant strain (410 ± 79 mg/dL). MAP was significantly higher in the SSLepRmutant strain vs. SS rats at the end of the study (198 ± 7 vs. 165 ± 7 mmHg, respectively). Administration of gemfibrozil only lowered MAP in SSLepRmutant rats (163 ± 8 mmHg). During the course of the study, proteinuria increased to 125 ± 22 mg/day in SS rats. However, proteinuria did not change in the SSLepRmutant strain and remained near baseline (693 ± 58 mg/day). Interestingly, treatment with gemfibrozil increased the progression of proteinuria by 77% in the SSLepRmutant strain without affecting proteinuria in SS rats. The renal injury in the SSLepRmutant strain progressed to CKD. Moreover, the kidneys from SSLepRmutant rats displayed significant glomerular injury with mesangial expansion and increased renal lipid accumulation and fibrosis compared to SS rats. Treatment with gemfibrozil significantly reduced glomerular injury and lipid accumulation and improved renal function. These data indicate that reducing plasma triglyceride levels with gemfibrozil inhibits hypertension and CKD associated with obesity in SSLepRmutant rats.
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Affiliation(s)
- Corbin A. Shields
- Department of Experimental Therapeutics and Pharmacology, University of Mississippi Medical Center, Jackson, MS, United States
| | - Bibek Poudel
- Department of Experimental Therapeutics and Pharmacology, University of Mississippi Medical Center, Jackson, MS, United States
| | - Kasi C. McPherson
- Department of Experimental Therapeutics and Pharmacology, University of Mississippi Medical Center, Jackson, MS, United States
| | - Andrea K. Brown
- Department of Experimental Therapeutics and Pharmacology, University of Mississippi Medical Center, Jackson, MS, United States
| | - Ubong S. Ekperikpe
- Department of Experimental Therapeutics and Pharmacology, University of Mississippi Medical Center, Jackson, MS, United States
| | - Evan Browning
- Department of Experimental Therapeutics and Pharmacology, University of Mississippi Medical Center, Jackson, MS, United States
| | - Lamari Sutton
- Department of Experimental Therapeutics and Pharmacology, University of Mississippi Medical Center, Jackson, MS, United States
| | - Denise C. Cornelius
- Department of Experimental Therapeutics and Pharmacology, University of Mississippi Medical Center, Jackson, MS, United States
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - Jan M. Williams
- Department of Experimental Therapeutics and Pharmacology, University of Mississippi Medical Center, Jackson, MS, United States
- *Correspondence: Jan M. Williams,
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27
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Kassam CN, Yiu VWM, Griffiths MH, Petchey WG. Educational case: a patient with proteinuria. Oxf Med Case Reports 2020; 2020:omz148. [PMID: 32551130 PMCID: PMC7293140 DOI: 10.1093/omcr/omz148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/28/2019] [Indexed: 11/13/2022] Open
Abstract
This is an educational case suitable for all readers, but aimed particularly at trainees preparing for MRCP. Using the example of a patient presenting to clinic with proteinuria, aspects of differential diagnosis, pathology and management are explored.
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Affiliation(s)
- Christopher N Kassam
- Department of Renal Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Vivian W M Yiu
- Department of Renal Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Department of Nephrology, West Suffolk NHS Foundation Trust, Bury St Edmunds, UK
| | - Meryl H Griffiths
- Department of Pathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - William G Petchey
- Department of Renal Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Department of Nephrology, West Suffolk NHS Foundation Trust, Bury St Edmunds, UK
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28
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Yang S, Cao C, Deng T, Zhou Z. Obesity-Related Glomerulopathy: A Latent Change in Obesity Requiring More Attention. Kidney Blood Press Res 2020; 45:510-522. [PMID: 32498064 DOI: 10.1159/000507784] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 04/06/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Obesity has become a major public health problem, and the prevalence of kidney diseases has increased in parallel. Among kidney diseases caused by metabolic disorders, obesity-related glomerulopathy (ORG) is secondary to obesity. SUMMARY ORG is mainly caused by glomerular hyperfiltration, dysregulation of hormone and cytokine secretion in adipose tissues, and ectopic lipid accumulation in renal cells. ORG is pathologically characterized by glomerular hypertrophy, with or without focal and segmental glomerulosclerosis. Patients with ORG usually present with proteinuria concomitant with metabolic disorders such as dyslipidemia and hypertension. Weight loss, RAAS inhibitors, and improved insulin resistance can reduce the progression of ORG. CONCLUSION ORG is a growing renal pathological change in obese individuals, and a comprehensive understanding of the disease is pivotal to avoid its occurrence and improve quality of life for those with obesity. Key Messages:This review comprehensively describes the characteristics of ORG in pathological changes, clinical manifestations, pathogeneses and treatments.
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Affiliation(s)
- Shuting Yang
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Chuqing Cao
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Tuo Deng
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Zhiguang Zhou
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China, .,Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, Changsha, China, .,National Clinical Research Center for Metabolic Diseases, Changsha, China,
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29
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Wendt R, He T, Latosinska A, Siwy J, Mischak H, Beige J. Proteomic characterization of obesity-related nephropathy. Clin Kidney J 2020; 13:684-692. [PMID: 32905225 PMCID: PMC7467596 DOI: 10.1093/ckj/sfaa016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/27/2020] [Indexed: 12/13/2022] Open
Abstract
Background Nephropathy related to obesity lacks a pathophysiological understanding and definite diagnostic pathways by biomarkers. Methods In this study we investigated the association between urinary peptides and body mass index (BMI) and renal function in proteome data sets from 4015 individuals. Results A total of 365 urinary peptides were identified to be significantly associated with BMI. The majority of these peptides were collagen fragments. In addition, most of the peptides also demonstrated a significant concordant association with estimated glomerular filtration rate (eGFR) in the investigated cohort, with the presence of diabetes exhibiting no significant association. A new classifier was developed, based on 150 urinary peptides, that enabled the distinction of non-obese subjects with preserved kidney function from obese, non-diabetic subjects with eGFR >45 mL/min/1.73 m2 in an independent cohort, with an area under the curve of 0.93. Conclusions On a molecular level, the data strongly suggest a link between obesity and fibrosis, which may be a major cause of obesity-related nephropathy.
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Affiliation(s)
- Ralph Wendt
- Department of Nephrology and Kuratorium for Dialysis and Transplantation Renal Unit, Hospital St Georg, Leipzig, Germany
| | - Tianlin He
- Mosaiques Diagnostics, Hannover, Germany
| | | | | | | | - Joachim Beige
- Department of Nephrology and Kuratorium for Dialysis and Transplantation Renal Unit, Hospital St Georg, Leipzig, Germany.,Department of Nephrology, Martin-Luther-University Halle/Wittenberg, Halle, Germany
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30
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Opazo-Ríos L, Mas S, Marín-Royo G, Mezzano S, Gómez-Guerrero C, Moreno JA, Egido J. Lipotoxicity and Diabetic Nephropathy: Novel Mechanistic Insights and Therapeutic Opportunities. Int J Mol Sci 2020; 21:E2632. [PMID: 32290082 PMCID: PMC7177360 DOI: 10.3390/ijms21072632] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023] Open
Abstract
Lipotoxicity is characterized by the ectopic accumulation of lipids in organs different from adipose tissue. Lipotoxicity is mainly associated with dysfunctional signaling and insulin resistance response in non-adipose tissue such as myocardium, pancreas, skeletal muscle, liver, and kidney. Serum lipid abnormalities and renal ectopic lipid accumulation have been associated with the development of kidney diseases, in particular diabetic nephropathy. Chronic hyperinsulinemia, often seen in type 2 diabetes, plays a crucial role in blood and liver lipid metabolism abnormalities, thus resulting in increased non-esterified fatty acids (NEFA). Excessive lipid accumulation alters cellular homeostasis and activates lipogenic and glycogenic cell-signaling pathways. Recent evidences indicate that both quantity and quality of lipids are involved in renal damage associated to lipotoxicity by activating inflammation, oxidative stress, mitochondrial dysfunction, and cell-death. The pathological effects of lipotoxicity have been observed in renal cells, thus promoting podocyte injury, tubular damage, mesangial proliferation, endothelial activation, and formation of macrophage-derived foam cells. Therefore, this review examines the recent preclinical and clinical research about the potentially harmful effects of lipids in the kidney, metabolic markers associated with these mechanisms, major signaling pathways affected, the causes of excessive lipid accumulation, and the types of lipids involved, as well as offers a comprehensive update of therapeutic strategies targeting lipotoxicity.
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Affiliation(s)
- Lucas Opazo-Ríos
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), 28040 Madrid, Spain; (L.O.-R.); (G.M.-R.); (C.G.-G.); (J.E.)
| | - Sebastián Mas
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), 28040 Madrid, Spain; (L.O.-R.); (G.M.-R.); (C.G.-G.); (J.E.)
| | - Gema Marín-Royo
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), 28040 Madrid, Spain; (L.O.-R.); (G.M.-R.); (C.G.-G.); (J.E.)
| | - Sergio Mezzano
- Laboratorio de Nefrología, Facultad de Medicina, Universidad Austral de Chile, 5090000 Valdivia, Chile;
| | - Carmen Gómez-Guerrero
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), 28040 Madrid, Spain; (L.O.-R.); (G.M.-R.); (C.G.-G.); (J.E.)
| | - Juan Antonio Moreno
- Department of Cell Biology, Physiology and Immunology, University of Cordoba, 14004 Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, 14004 Cordoba, Spain
- Hospital Universitario Reina Sofía, 14004 Cordoba, Spain
| | - Jesús Egido
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), 28040 Madrid, Spain; (L.O.-R.); (G.M.-R.); (C.G.-G.); (J.E.)
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Veiga G, Alves B, Perez M, Alcantara LV, Raimundo J, Zambrano L, Encina J, Pereira EC, Bacci M, Murad N, Fonseca F. NGAL and SMAD1 gene expression in the early detection of diabetic nephropathy by liquid biopsy. J Clin Pathol 2020; 73:713-721. [PMID: 32184218 DOI: 10.1136/jclinpath-2020-206494] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Diabetic nephropathy (DN) is a disease that progresses with the slow and progressive decline of the glomerular filtration rate (GFR); the installation of this pathology is silent and one of the major causes of death in patients with diabetes. AIMS To identify new molecular biomarkers for early identification of the onset of DN in patients with type II diabetes mellitus (DM2). We studied the expression profile of the genes; suppressor of mothers against decapentaplegic type 1 (SMAD1), neutrophil gelatinase-associated lipocalin (NGAL) and type IV collagen (COLIV1A) in peripheral blood and urine sediment samples. METHODS Ninety volunteers, 51 with DM2 and 39 healthy, were recruited from the Faculdade de Medicina do ABC outpatient clinic. We conducted an interview and collected anthropometric data, as well as blood and urine samples for biochemical evaluation and real-time PCR amplification of the genes of interest. RESULTS Gene expression data: peripheral blood NGAL (DM2 0.09758±0.1914 vs CTL 0.02293±0.04578), SMAD1 (blood: DM2 0.01102±0.04059* vs CTL 0.0001317±0.0003609; urine: DM2 0.7195±2.344* vs CTL 0.09812±0.4755), there was no significant expression of COLIV1A. These genes demonstrated good sensitivity and specificity in the receiving operating characteristic curve evaluation. CONCLUSION Our data suggest the potential use of NGAL and SMAD1 gene expression in peripheral blood and urine samples as early biomarkers of DN.
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Affiliation(s)
- Glaucia Veiga
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil
| | - Beatriz Alves
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil
| | - Matheus Perez
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil
| | | | - Joyce Raimundo
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil
| | - Lysien Zambrano
- Universidad Nacional Autónoma de Honduras, Tegucigalpa, Francisco Morazán, Honduras
| | - Jessica Encina
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil
| | - Edimar Cristiano Pereira
- Pharmaceutical Sciences Department, Universidade Federal de São Paulo, Diadema, São Paulo, Brazil
| | - Marcelo Bacci
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil
| | - Neif Murad
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil
| | - Fernando Fonseca
- Centro Universitário Saúde ABC/Faculdade de Medicina do ABC, Santo Andre, Brazil.,Pharmaceutical Sciences Department, Universidade Federal de São Paulo, Diadema, São Paulo, Brazil
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32
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Dhont E, Van Der Heggen T, De Jaeger A, Vande Walle J, De Paepe P, De Cock PA. Augmented renal clearance in pediatric intensive care: are we undertreating our sickest patients? Pediatr Nephrol 2020; 35:25-39. [PMID: 30374606 DOI: 10.1007/s00467-018-4120-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/04/2018] [Accepted: 10/16/2018] [Indexed: 10/28/2022]
Abstract
Many critically ill patients display a supraphysiological renal function with enhanced renal perfusion and glomerular hyperfiltration. This phenomenon described as augmented renal clearance (ARC) may result in enhanced drug elimination through renal excretion mechanisms. Augmented renal clearance seems to be triggered by systemic inflammation and therapeutic interventions in intensive care. There is growing evidence that ARC is not restricted to the adult intensive care population, but is also prevalent in critically ill children. Augmented renal clearance is often overlooked due to the lack of reliable methods to assess renal function in critically ill children. Standard equations to calculate glomerular filtration rate (GFR) are developed for patients who have a steady-state creatinine production and a stable renal function. Those formulas are not reliable in critically ill patients with acutely changing GFR and tend to underestimate true GFR in patients with ARC. Tools for real-time, continuous, and non-invasive measurement of fluctuating GFR are most needed to identify changes in kidney function during critical illness and therapeutic interventions. Such devices are currently being validated and hold a strong potential to become the standard of practice. In the meantime, urinary creatinine clearance is considered the most reliable method to detect ARC in critically ill patients. Augmented renal clearance is clearly associated with subtherapeutic antimicrobial concentrations and subsequent therapeutic failure. This warrants the need for adjusted dosing regimens to optimize pharmacokinetic and pharmacodynamic target attainment. This review aims to summarize current knowledge on ARC in critically ill children, to give insight into its possible pathophysiological mechanism, to evaluate screening methods for ARC in the pediatric intensive care population, and to illustrate the effect of ARC on drug exposure, therapeutic efficacy, and clinical outcome.
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Affiliation(s)
- Evelyn Dhont
- Department of Pediatric Intensive Care, Ghent University Hospital, Ghent, Belgium. .,Pediatric Intensive Care 1K12D, Ghent University Hospital, Heymanslaan 10, 9000, Ghent, Belgium.
| | | | - Annick De Jaeger
- Department of Pediatric Intensive Care, Ghent University Hospital, Ghent, Belgium
| | - Johan Vande Walle
- Department of Pediatrics, Ghent University Hospital, Ghent, Belgium.,Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Peter De Paepe
- Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
| | - Pieter A De Cock
- Department of Pediatric Intensive Care, Ghent University Hospital, Ghent, Belgium.,Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium.,Department of Pharmacy, Ghent University Hospital, Ghent, Belgium
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Gong X, Liang L, Chen Q, Jia X, Tang L, Zhang L, Li W, Wang Z, Kong X, Xu D. Association Between Body Composition and Glomerular Hyperfiltration Among Chinese Adults. Ther Apher Dial 2019; 24:439-444. [PMID: 31574579 DOI: 10.1111/1744-9987.13436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/04/2019] [Accepted: 09/17/2019] [Indexed: 11/30/2022]
Abstract
High body mass index (BMI) is the most common parameter to assess excess adiposity, and has been linked to glomerular hyperfiltration (GH). However, BMI may be misleading in the estimation of body fat content due to its inability to discriminate between body fat and lean mass. In recent years, the convenient biological impedance analysis has made prediction of certain diseases somewhat feasible and accessible using body composition (BC). Accordingly, we conducted a cross-sectional study to explore the association between BC and GH among Chinese adult population. A total of 6902 adults (aged 38.6 ± 8.3 years, 70.1% males) who consecutively visited the Health Checkup Clinic were enrolled. BC including fat mass and lean body mass (LBM) was evaluated by biological impedance analysis. The upper quartile of eGFR which exceeded 117.3 mL/min/1.73 m2 was defined as GH, in comparison with the lower three quartiles (control group). As a categorical outcome, GH subjects had higher fat/LBM than the control group, which was 34.7 ± 10.9 (%) vs. 34.0 ± 10.5 (%), P = 0.01; however, the BMI in GH group was lower than in the control group, which was 24.5 ± 3.7 (%) vs. 24.9 ± 3.6 (%), P < 0.001. Fat/height and Fat/BSA were not significantly different between the two groups. Moreover, after adjusting for potential confounders, fat/LBM significantly correlated with GH (OR = 2.09, 95% CI, 1.11 to 3.93). The study revealed that fat/LBM significantly correlated with GH among Chinese adult population, which highlights that adiposity might be an important and potentially modifiable determinant of GH.
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Affiliation(s)
- Xiaojie Gong
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Liming Liang
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Qinlan Chen
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaoyan Jia
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Lijun Tang
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Lei Zhang
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Wenbin Li
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Zunsong Wang
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Xianglei Kong
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Dongmei Xu
- Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,Shandong Provincial Key Laboratory for Rheumatic Disease and Translational Medicine, Jinan, China.,Nephrology Research Institute of Shandong Province, Jinan, China
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34
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Koch VH. The effects of obesity on kidney function: a challenge for nephrologists. ACTA ACUST UNITED AC 2019; 41:162-165. [PMID: 31173042 PMCID: PMC6699440 DOI: 10.1590/2175-8239-jbn-2019-0064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/08/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Vera H Koch
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, São Paulo, SP, Brasil
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35
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Ferrara D, Montecucco F, Dallegri F, Carbone F. Impact of different ectopic fat depots on cardiovascular and metabolic diseases. J Cell Physiol 2019; 234:21630-21641. [DOI: 10.1002/jcp.28821] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/17/2019] [Accepted: 04/29/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Daniele Ferrara
- Department of Internal Medicine, First Clinic of Internal Medicine University of Genoa Genoa Italy
| | - Fabrizio Montecucco
- Centre of Excellence for Biomedical Research (CEBR), Department of Internal Medicine, First Clinic of Internal Medicine University of Genoa Genoa Italy
- IRCCS Ospedale Policlinico San Martino Genoa—Italian Cardiovascular Network Genoa Italy
| | - Franco Dallegri
- Department of Internal Medicine, First Clinic of Internal Medicine University of Genoa Genoa Italy
- IRCCS Ospedale Policlinico San Martino Genoa—Italian Cardiovascular Network Genoa Italy
| | - Federico Carbone
- Department of Internal Medicine, First Clinic of Internal Medicine University of Genoa Genoa Italy
- IRCCS Ospedale Policlinico San Martino Genoa—Italian Cardiovascular Network Genoa Italy
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Schelb JE, De Paula RB, Ezequiel DGA, Costa MB. Obesidade e doença renal: aspectos fisiopatológicos. HU REVISTA 2019. [DOI: 10.34019/1982-8047.2018.v44.13982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A epidemia de obesidade observada nas últimas décadas é acompanhada de aumento exponencial de doenças crônicas relacionadas, com destaque diabetes mellitus tipo 2, hipertensão arterial sistêmica, dislipidemia e doenças cardiovasculares. Do mesmo modo, a obesidade constitui fator de risco independente para o desenvolvimento de doença renal crônica, condição associada a elevados índices de morbidade e de mortalidade. A obesidade causa lesão renal de maneira indireta, por meio de sua estreita associação com hipertensão arterial sistêmica e com diabetes mellitus tipo 2 e de maneira direta, ao induzir adaptações glomerulares que culminam na glomerulopatia específica da obesidade. Além disso, o excesso de peso contribui para o agravamento de glomerulopatias pré-existentes. Múltiplos fatores explicam o desenvolvimento e o agravamento das lesões renais associadas à obesidade, em especial alterações hemodinâmicas, inflamatórias e metabólicas. Nesse contexto, a redução do peso corporal com ênfase nas alterações metabólicas e inflamatórias bem como o tratamento da hipertensão arterial e do diabetes mellitus constituem o primeiro passo para a prevenção primária e secundária do desenvolvimento de doença renal crônica. Nesta revisão serão apresentados os principais mecanismos fisiopatológicos da lesão renal associada à obesidade.
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Romero CA, Carretero OA. A Novel Mechanism of Renal Microcirculation Regulation: Connecting Tubule-Glomerular Feedback. Curr Hypertens Rep 2019; 21:8. [PMID: 30659366 DOI: 10.1007/s11906-019-0911-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW In this review, we summarized the current knowledge of connecting tubule-glomerular feedback (CTGF), a novel mechanism of renal microcirculation regulation that integrates sodium handling in the connecting tubule (CNT) with kidney hemodynamics. RECENT FINDINGS Connecting tubule-glomerular feedback is a crosstalk communication between the CNT and the afferent arteriole (Af-Art), initiated by sodium chloride through the epithelial sodium channel (ENaC). High sodium in the CNT induces Af-Art vasodilation, increasing glomerular pressure and the glomerular filtration rate and favoring sodium excretion. CTGF antagonized and reset tubuloglomerular feedback and thus increased sodium excretion. CTGF is absent in spontaneous hypertensive rats and is overactivated in Dahl salt-sensitive rats. CTGF is also modulated by angiotensin II and aldosterone. CTGF is a feedback mechanism that integrates sodium handling in the CNT with glomerular hemodynamics. Lack of CTGF could promote hypertension, and CTGF overactivation may favor glomerular damage and proteinuria. More studies are needed to explore the alterations in renal microcirculation and the role of these alterations in the genesis of hypertension and glomerular damage in animals and humans. KEY POINTS • CTGF is a vasodilator mechanism that regulates afferent arteriole resistance. • CTGF is absent in spontaneous hypertensive rats and overactivated in Dahl salt-sensitive rats. • CTGF in excess may promote glomerular damage and proteinuria, while the absence may participate in sodium retention and hypertension.
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Affiliation(s)
- Cesar A Romero
- Hypertension and Vascular Research Division, Department of Internal Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI, 48202-2689, USA.
| | - Oscar A Carretero
- Hypertension and Vascular Research Division, Department of Internal Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI, 48202-2689, USA
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Ohira M, Yamaguchi T, Saiki A, Nakamura S, Tanaka S, Oka R, Watanabe Y, Sato Y, Oshiro T, Murano T, Tatsuno I. Laparoscopic Sleeve Gastrectomy Significantly Increases Serum Lipoprotein Lipase Level in Obese Patients. Obes Facts 2019; 12:357-368. [PMID: 31167211 PMCID: PMC6696888 DOI: 10.1159/000500360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/15/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Obesity is one of the causes of metabolic disorders. Laparoscopic sleeve gastrectomy (LSG) confers beneficial effects not only on body weight (BW) but also on metabolic disorders. The lipoprotein lipase (LPL) level in preheparin serum is associated with visceral adipose tissue and reflects insulin resistance. However, the change in serum preheparin LPL levels after LSG remains unclear. This study aimed to examine the effect of LSG on preheparin LPL level in obese patients compared with nonsurgical treatment. METHODS We retrospectively reviewed a total of 100 obese patients who were treated for obesity and had preheparin LPL levels measured before and 12 months after LSG or after 12 months of nonsurgical treatment. Fifty-six patients received LSG (LSG group), and 44 patients had no surgical treatment (nonsurgical group). We compared clinical parameters such as body mass index (BMI), hemoglobin A1c (HbA1c), and preheparin LPL level before and 12 months after treatment. RESULTS BMI and HbA1c decreased significantly in both groups, but decreases in both parameters were greater in the LSG group than in the nonsurgical group. Estimated glomerular filtration was significantly improved only in the LSG group. Preheparin LPL level increased significantly only in the LSG group (from 45.8 ± 21.6 to 75.0 ± 34.9 ng/mL, p < 0.001). Multiple regression identified LSG and decreased BMI as independent predictors of preheparin LPL level increase. CONCLUSIONS These results suggest that LSG independently increases pre-heparin LPL level beyond BW reduction in obese patients.
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Affiliation(s)
- Masahiro Ohira
- Center for Diabetes, Endocrinology, and Metabolism, Toho University Sakura Medical Center, Chiba, Japan,
| | - Takashi Yamaguchi
- Center for Diabetes, Endocrinology, and Metabolism, Toho University Sakura Medical Center, Chiba, Japan
| | - Atsuhito Saiki
- Center for Diabetes, Endocrinology, and Metabolism, Toho University Sakura Medical Center, Chiba, Japan
| | - Shoko Nakamura
- Center for Diabetes, Endocrinology, and Metabolism, Toho University Sakura Medical Center, Chiba, Japan
| | - Shou Tanaka
- Center for Diabetes, Endocrinology, and Metabolism, Toho University Sakura Medical Center, Chiba, Japan
| | - Rena Oka
- Center for Diabetes, Endocrinology, and Metabolism, Toho University Sakura Medical Center, Chiba, Japan
| | - Yasuhiro Watanabe
- Center for Diabetes, Endocrinology, and Metabolism, Toho University Sakura Medical Center, Chiba, Japan
| | - Yuta Sato
- Center for Diabetes, Endocrinology, and Metabolism, Toho University Sakura Medical Center, Chiba, Japan
| | - Takashi Oshiro
- Department of Surgery, Toho University Sakura Medical Center, Chiba, Japan
| | - Takeyoshi Murano
- Department of Clinical Laboratory Medicine, Toho University Sakura Medical Center, Chiba, Japan
| | - Ichiro Tatsuno
- Center for Diabetes, Endocrinology, and Metabolism, Toho University Sakura Medical Center, Chiba, Japan
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El Shebini SM, Moaty MIA, Fouad S, Ahmed NH, Tapozada ST. Obesity Related Metabolic Disorders and Risk of Renal Disease: Impact of Hypocaloric Diet and Avena Sativa Supplement. Open Access Maced J Med Sci 2018; 6:1376-1381. [PMID: 30159060 PMCID: PMC6108808 DOI: 10.3889/oamjms.2018.292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/28/2018] [Accepted: 07/03/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The recognition of the complications of obesity in various organs and systems should make clinicians and dietitians aware of the importance of early strategies to fight obesity in all age groups. AIM The objective of this study was to evaluate the early effect of using Avena sativa (oat) flour supplement compared to a hypocaloric diet in the management of obesity-related metabolic disorders. MATERIAL AND METHODS Snack was prepared from wholemeal wheat flour (100% extraction) and oat flour. Chemical analysis of the raw materials and the formulae was carried out. 106 obese women with their mean body mass index were 37.73 ± 0.56 kg/m2 volunteered for 8 weeks period. They were divided into two groups; group (A), consumed hypocaloric diet supplemented by the prepared snack, while group (B) subjects followed the low caloric balanced diet. All patients were monitored clinically, anthropometrically, dietary 24 h recall and biochemically. RESULT Data demonstrated significantly decreased in the mean levels of the anthropometric parameters. Group (A) showed a higher decrease in the waist circumference, WHR, body fat% and SBP; while in group (B) weight, BMI, chest circumference and DBP were the most affected parameters. The reduction in the biochemical parameters was higher in the group (A). At the baseline, high values of cystatin-C were found in both groups which may indicate early renal injury. At the end of the study, a significant reduction of the cystatin concentration was observed among both groups (-24.54 & -12.23%). CONCLUSION The healthy effect of the dietary oat supplement on the reduction of central obesity, percentage body fat and different metabolic disorders criteria was confirmed than with hypocaloric diet.
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Affiliation(s)
- Salwa M. El Shebini
- Nutrition and Food Science Department, National Research Centre, Dokki, Giza, Egypt
| | - Maha I. A. Moaty
- Nutrition and Food Science Department, National Research Centre, Dokki, Giza, Egypt
| | - Suzanne Fouad
- Nutrition and Food Science Department, National Research Centre, Dokki, Giza, Egypt
| | - Nihad H. Ahmed
- Nutrition and Food Science Department, National Research Centre, Dokki, Giza, Egypt
| | - Salwa T. Tapozada
- Nutrition and Food Science Department, National Research Centre, Dokki, Giza, Egypt
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