Obesity and kidney: The new insight

During the last 15 years equivalent dramatic rise in the prevalence of obesity and end stage renal disease (ESRD) escalating the interest on the role of obesity-related kidney disease. Obesity not only increases the risk of progression of preexisting renal disease but is itself also an independent risk factor of renal injury. The best-known renal disease secondary to obesity is obesity-related glomerulopathy (ORG). Fortunately, not all the obese persons develop ORG. Recently, the comprehensive epidemiologic studies discovered that Population attributable risk (PAR) of kidney disease due to obesity in the USA and industrialized countries is 33,12% and 24%, retrospectively. So, it is plausible that obesity is not the sole factor causing ORG and there may be extra or predisposing factors that explain the considerable difference among obese individuals to develop or not ORG. The factors predisposing obese individuals to ORG are : a. Low nephron number (preterm or low birth weight, intra-uterine growth retardation); b. Nephron mass reduction (congenital renal anomalies or nephectomy); c. Progressive loss of functioning nephron (chronic kidney disease, aging); d. Visceral fat obesity; e. Components of metabolic syndrome and f. Obesity-associated complications. Understanding the listed factors that predispose patients to renal adaptive or maladaptive obesity related changes could direct the set up the preventive and therapeutic intervention to slow the epidemic of ESRD