Kidney damage in case of obesity: variants of clinical course, mechanisms of development


DOI: https://dx.doi.org/10.18565/therapy.2019.6.87-93

Bobkova I.N., Gussaova S.S., Stavrovskaya E.V.

I.M. Sechenov First Moscow State medical University of the Ministry of Healthcare of Russia (Sechenov university)
Kidney damage in obesity case is a complex multifactorial process. It includes direct factors close related to obesity which determine the development of specific obesity-associated glomerulopathy, as well as a number of conditions associated with obesity (insulin resistance, metabolic syndrome, diabetes mellitus, dyslipidemia, hyperuricemia, arterial hypertension), which predispose to the development of chronic kidney disease.
Influence of obesity at the kidneys is also manifested by an increase of the frequency of nephrolithiasis and malignant renal neoplasms. One of the leading pathophysiological mechanisms of kidney damage in obesity are disorders of intrarenal hemodynamics with the development of hyperfiltration and its consequences, due to the presence of relative oligonephronia, and renin-angiotensin-aldosterone system (RAAS) activation. An important role belongs to the direct effect of adipose tissue on the kidneys, which is associated with the endocrine activity of substances produced by adipocytes - adipocytokines. They trigger inflammation, oxidative stress, apoptosis, and activate RAAS. Ectopic deposits of fat located intracellularly, perivascularly, in the renal sinus also have a toxic effect on the kidneys. The review discusses in details the molecular mechanisms underlying in the basis of renal hemodynamics disorders, lipotoxicity, and insulin resistance in obesity, describes various types of kidney damage. A particular emphasis to specific kidney damage - obesity-associated glomerulopathy is made.
Keywords: activation of the renin-angiotensin-aldosterone system, oligonephronia, intraglomerular hypertension, obesity-associated glomerulopathy, adipocytokines, hyperfiltration, chronic kidney disease, obesity
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About the Autors

Irina N. Bobkova, MD, professor of the Department of internal, occupational diseases and rheumatology of I.M. Sechenov First Moscow State medical University of the Ministry of Healthcare of Russia (Sechenov university). Address: 119991, Moscow, 11/4–5 Rossolimo Str. Tel.: +7 (499) 248-41-66. E-mail: irbo.mma@mail.ru
Sonya S. Gussaova, postgraduate student of the Department of internal, occupational diseases and rheumatology of I.M. Sechenov First Moscow State medical University of the Ministry of Healthcare of Russia (Sechenov university). Address: 119991, Moscow, 11/4–5 Rossolimo Str. Tel.: +7 (499) 248-41-66. E-mail: gussaova-sonya@mail.ru
Ekaterina V. Stavrovskaya, PhD., associate professor of the Department of internal, occupational diseases and rheumatology of I.M. Sechenov First Moscow State medical University of the Ministry of Healthcare of Russia (Sechenov university). Address: 119991, Moscow, 11/4–5 Rossolimo Str. Tel.: +7 (499) 248-41-66. E-mail: eka-stavrovskaya@yandex.ru


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