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Obesity and the metabolic syndrome are significant risk factors for the development of chronic kidney disease.
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The pathophysiology of obesity-related kidney disease is multifactorial and includes hemodynamic factors (hypertension and hyperfiltration), inflammation, and renal lipotoxicity.
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Children with severe obesity have an increased prevalence of early kidney abnormalities, although the natural history and clinical spectrum of obesity-related kidney disease in children are not known.
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Treatment
Childhood Obesity and the Metabolic Syndrome
Section snippets
Key points
Childhood Obesity
Childhood adiposity is commonly measured using body mass index (BMI), defined as the weight in kilograms divided by the square of the height in meters. Because the distribution of BMI changes with age, BMI levels must be interpreted relative to age- and gender-specific normative distributions. Therefore, expert recommendations to identify elevated BMI in children are based on percentile cutoffs rather than absolute values. In 2005, a committee composed of representatives from the American
The epidemic of obesity, the metabolic syndrome, and chronic kidney disease
There has been increasing interest in the association of obesity with CKD, in part generated by a parallel increase in obesity and kidney disease over recent decades. Concurrent with the increase in obesity from 1980 to 2000, the incidence of ESRD nearly quadrupled.19 Epidemiologic studies have confirmed obesity is a strong, independent risk factor for developing CKD and ESRD.20, 21, 22 Vivante and colleagues7 investigated the incidence of ESRD in 1.2 million adolescents followed for a mean of
Mechanisms of kidney disease in obesity and the metabolic syndrome
Despite the burgeoning evidence linking obesity with CKD, the mechanism of obesity-related kidney disease has remained largely elusive. Proposed pathways of kidney injury in obesity and the metabolic syndrome include hemodynamic factors, inflammatory/metabolic effects, and lipotoxicity (Fig. 1).
Presentation and Disease Course
Obesity-related kidney disease often presents as isolated proteinuria with or without renal insufficiency. Proteinuria may be discovered incidentally or as part of an evaluation for other obesity-related comorbidities. Because kidney disease is often asymptomatic and may be present for years before detection, targeted screening for microalbuminuria in obese children at higher risk for kidney disease is a reasonable approach. This screening should include those with insulin resistance, diabetes,
Summary
Obesity and the obesity-related metabolic syndrome are now recognized as significant causes of CKD. The injurious renal effects of severe obesity are present in childhood, although the natural history and clinical spectrum of obesity-related kidney disease in children are not known. Treatment options include weight loss and angiotensin-converting enzyme inhibitors, although kidney disease may progress despite these measures. Future research efforts aimed at early identification and novel
References (82)
- et al.
Association between obesity and kidney disease: a systematic review and meta-analysis
Kidney Int
(2008) - et al.
Metabolic syndrome in childhood predicts adult metabolic syndrome and type 2 diabetes mellitus 25 to 30 years later
J Pediatr
(2008) - et al.
The metabolic syndrome in children and adolescents
Lancet
(2007) - et al.
US renal data system 2013 annual data report
Am J Kidney Dis
(2014) - et al.
Obesity and prevalent and incident CKD: the hypertension detection and follow-up program
Am J Kidney Dis
(2005) - et al.
Obesity-related glomerulopathy: an emerging epidemic
Kidney Int
(2001) - et al.
The risk of chronic kidney disease in a metabolically healthy obese population
Kidney Int
(2015) - et al.
Kidney pathological changes in metabolic syndrome: a cross-sectional study
Am J Kidney Dis
(2009) - et al.
Renal injury in the extremely obese patients with normal renal function
Kidney Int
(2008) - et al.
Association of metabolic syndrome with kidney function and histology in living kidney donors
Am J Transplant
(2013)
Glomerular hyperfiltration: a new marker of metabolic risk
Kidney Int
The hyperfiltration theory: a paradigm shift in nephrology
Kidney Int
Obesity, inflammation, and kidney disease
Kidney Int Suppl
Markers of inflammation predict the long-term risk of developing chronic kidney disease: a population-based cohort study
Kidney Int
Leptin stimulates proliferation and TGF-beta expression in renal glomerular endothelial cells: potential role in glomerulosclerosis [see comments]
Kidney Int
Leptin mediates the increase in blood pressure associated with obesity
Cell
Diet-induced obesity in C57BL/6J mice causes increased renal lipid accumulation and glomerulosclerosis via a sterol regulatory element-binding protein-1c-dependent pathway
J Biol Chem
Effect of lipoproteins on cultured human mesangial cells
Am J Kidney Dis
Protection of mitochondria prevents high-fat diet-induced glomerulopathy and proximal tubular injury
Kidney Int
Role of sterol regulatory element-binding protein 1 in regulation of renal lipid metabolism and glomerulosclerosis in diabetes mellitus
J Biol Chem
Lipotoxicity
Kidney Int
Urinary free fatty acids bound to albumin aggravate tubulointerstitial damage
Kidney Int
Beneficial effects of weight loss in overweight patients with chronic proteinuric nephropathies
Am J Kidney Dis
KDIGO Clinical Practice Guideline for Lipid Management in CKD: summary of recommendation statements and clinical approach to the patient
Kidney Int
Laparoscopic sleeve gastrectomy in obese adolescents: results in 51 patients
Surg Obes Relat Dis
Laparoscopic adjustable gastric banding for morbidly obese adolescents affects android fat loss, resolution of comorbidities, and improved metabolic status
J Am Coll Surg
Bariatric surgery is associated with improvement in kidney outcomes
Kidney Int
Estimated GFR before and after bariatric surgery in CKD
Am J Kidney Dis
Kidney outcomes three years after bariatric surgery in severely obese adolescents
Kidney Int
Worldwide trends in childhood overweight and obesity
Int J Pediatr Obes
Prevalence of childhood and adult obesity in the United States, 2011-2012
JAMA
Trends in metabolic syndrome severity and lifestyle factors among adolescents
Pediatrics
Tracking of childhood overweight into adulthood: a systematic review of the literature
Obes Rev
Childhood adiposity, adult adiposity, and cardiovascular risk factors
N Engl J Med
Body mass index in 1.2 million adolescents and risk for end-stage renal disease
Arch Intern Med
Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report
Pediatrics
Predicting obesity in young adulthood from childhood and parental obesity
N Engl J Med
The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study
Pediatrics
Relationship of childhood obesity to coronary heart disease risk factors in adulthood: the Bogalusa Heart Study
Pediatrics
Prevalence of metabolic syndrome (MS) in children and adolescents with varying degrees of obesity
Clin Endocrinol
Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study
J Pediatr
Cited by (65)
Mastication in overweight and obese children: A comparative cross-sectional study
2023, Jornal de PediatriaCitation Excerpt :Childhood obesity is an important concern in terms of public health because of its association with cardiovascular disease risk factors, such as; type 2 diabetes mellitus, dyslipidemia, and hypertension.7 Many of the associated cardiovascular disease risk factors present a strong tendency to persist into adolescence and adult life.8 Worldwide, about 43 million children under 5 years of age are overweight.9
Adolescent obesity
2023, Encyclopedia of Child and Adolescent Health, First EditionPrevalent endocrinological abnormalities in adolescence
2022, Medicine (Spain)Not Only Metabolic Complications of Childhood Obesity
2024, Nutrients
Financial Disclosure: There are no conflicts of interest to disclose.