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RESEARCH
Nephrology

Diabetes and Obesity in Renal Disease (DIABESITY)

Special Article Collection published in Nephron.

Contributions From CME Course of the DIABESITY Working Group

Authors: Gema Medina Gómez, Esteban Porrini

The rapid growth of obesity, metabolic syndrome, and type 2 diabetes represents a major challenge in nephrology [1]. Obesity precedes type 2 diabetes mellitus and hypertension, two major risk factors for chronic kidney disease (CKD) [1]. Moreover, obesity, especially in the context of metabolic syndrome, is an independent risk factor for CKD [1]. Finally, in patients with established CKD of diverse causes, obesity is accelerated by renal function loss over time [1]. However, the pathogenesis of renal damage in obesity and metabolic syndrome is not clearly known. In obesity, the energy excess leads to a chronic stressful environment resulting in adipose tissue hypertrophy until adipocytes reach their expansion limit. From this point on, the excess of toxic lipid species accumulates ectopically in different organs, inducing a harmful effect known as lipotoxicity [1, 2]. Emerging evidence from the last decades indicates renal lipotoxicity as a major cause of renal damage in obesity. Inflammation is another important area of research and could be involved in kidney damage in these metabolic complications. In any case, the intricate interaction between lipotoxicity and inflammation in the induction of renal damage is not fully elucidated. There is a lack of animal models resembling renal disease in obesity and metabolic syndrome, particularly related to chronic damage. Limited data on therapeutic options in renal disease in obesity are available. Data on bariatric surgery in patients with severe obesity and patients with CKD are scarce. However, recent evidence on cardiovascular and renal protection of specific diets and new drugs appears to offer promising alternatives for patients with diabetes, obesity, and kidney disease.


References
  1. de Vries AP, Ruggenenti P, Ruan XZ, Praga M, Cruzado JM, Bajema IM, et al; ERA-EDTA Working Group Diabesity. Fatty kidney: emerging role of ectopic lipid in obesity-related renal disease. Lancet Diabetes Endocrinol. 2014 May;2(5):417–26.
  2. Martinez-Garcia C, Izquierdo-Lahuerta A, Vivas Y, Velasco I, Yeo TK, Chen S, et al. Renal lipotoxicity-associated inflammation and insulin resistance affects actin cytoskeleton organization in podocytes. PLoS One. 2015;10(11):e0142291.
 



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