Envíe este artículo por correo electrónico (Inicie sesión)
Enviar un correo electrónico al autor/a (Inicie sesión) Open Journal Systems
La obesidad en la edad pediátrica y su relación con enfermedad renal crónica
Resumen
En las últimas décadas, la obesidad y la enfermedad renal crónica (ERC) se han incrementado a nivel mundial de manera paralela. En este artículo se abordan los aspectos actuales de la obesidad sobre el daño renal, con especial énfasis en lo que ocurre en edades pediátricas. Si bien la obesidad se ha relacionado de forma estrecha con la diabetes mellitus tipo 2 y con la hipertensión arterial sistémica, la reducción de la sensibilidad de insulina es un mecanismo directo para el daño renal. Los mecanismos fisiopatogénicos de la obesidad sobre el daño renal incluyen hiperflitración e hipertrofia glomerular, hipercelularidad y ensanchamiento de las regiones mesangiales, mientras que la falta de sensibilidad a la insulina aumenta los efectos de angiotensina II, agrava la proteinuria e induce la producción de citocinas inflamatorias. Múltiples estudios epidemiológicos documentan la relación del incremento del índice de masa corporal con el desarrollo de ERC; sin embargo, la mayoría son de población adulta. En niños, la información es limitada pero congruente con los hallazgos en adultos. En contraste, existen estudios donde se observa que las intervenciones enfocadas a la disminución de peso mejoran y limitan el daño renal, ya que se reducen la proteinuria, las cifras de presión arterial y la tasa de filtración glomerular. Todo lo anterior hace reflexionar sobre la necesidad de mejorar los esfuerzos para disminuir la prevalencia de la obesidad desde etapas tempranas de la vida, lo cual llevará a que en el futuro existan menor número de pacientes con ERC.
Palabras clave
Referencias
Alicic R, Patakoti R, Tuttle K. Direct and indirect effects of obesity on the kidney. Advs Chronic Kidney Dis. 2013; 20: 121-7.
Luque de Pablos A, Morales M, Izquierdo E, Aparicio C, Fernández Escribano A. Insuficiencia renal crónica en niños. Pediatr Integral. 2000; 5: 929-44.
Hogg R, Furth S, Lemley K, Portman R, Schwartz G, Coresh J, et al. National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Chronic Kidney Disease in Children and Adolescents: evaluation, classification, and stratification. Pediatrics. 2003; 111: 1416-21.
Savino A, Pellicia P, Chiarelli F, Mohn A. Obesity-related renal injury in childhood. Horm Res Pediatr. 2010; 303-11.
Ritz E. Obesity and CKD: How to assess the risk? Am J Kidney Dis. 2008; 52:1-6.
Srivastava T. Nondiabetic consequences of obesity on kidney. Pediatr Nephrol. 2006; 21: 463-70.
Foster M, Hwang S, Larson M, Lichtman J, Parikh N, Vasan R, et al. Overweight, obesity, and the development of stage 3 CKD: the Framingham Heart Study. Am J Kidney Dis. 2008; 52: 39-48.
Gelber R, Kurth T, Kausz A, Manson J, Buring J, Levey A, et al. Association between body mass index and CKD in apparently healthy men. Am J Kidney Dis. 2005; 46: 871-80.
Wang Y, Chen X, Klag M, Caballero B. Epidemic of childhood obesity: implications for kidney disease. Adv Chronic Kidney Dis. 2006; 13: 336-51.
Elsayed E, Sarnak M, Tighiouart H, Griffith J, Kurth T, Salem D, et al. Waist-to-hip ratio, body mass index, and subsequent kidney disease and death. Am J Kidney Dis. 2008; 52: 29-38.
Pinto-Sietsma S, Navis G, Janssen W, de Zeeuw D, Gans R, de Jong P. A central body fat distribution is related to renal function impairment, even in lean subjects. Am J Kidney Dis. 2003; 41: 733-41.
Sasatomi Y, Tada M, Uesugi N, Hisano S, Takebayashi S. Obesity associated with hypertension or hyperlipidemia accelerates renal damage. Pathobiology. 2001; 69: 113-8.
Pedrinelli R, Dell’Omo G, Penno G, Mariani M. Non-diabetic microalbuminuria, endothelial dysfunction and cardiovascular disease. Vasc Med 2001; 6: 257-64.
Burgert T, Dziura J, Yeckel C, Taksali S, Weiss R, Tamborlane W, et al. Microalbuminuria in pediatric obesity: prevalence and relation to other cardiovascular risk factors. Int J Obes 2006; 30: 273-80.
Verhulst S, Van Hoeck K, Schrauwen N, Haentjens D, Rooman R, Van Gaal L, et al. Sleep-disordered breathing and proteinuria in overweight and obese children and adolescents. Horm Res. 2008; 70: 224-9.
Wong C, Gipson D, Gillen D, Emerson S, Koepsell T, Sherrard D, et al. Anthropometric measures and risk of death in children with endstage renal disease. Am J Kidney Dis. 2000; 36: 811-9.
Filler G, Payne R, Orrbine E, Clifford T, Drukker A, McLaine P. Changing trends in the referral patterns of pediatric nephrology patients. Pediatr Nephrol. 2005; 20: 603-8.
Hanevold C, Ho P, Talley L, Mitsnefes M. Obesity and renal transplant outcome: A Report of the North American Pediatric Renal Transplant Cooperative Study. Pediatrics. 2005; 115: 352-6.
Mitsnefes M, Khoury P, McEnery P. Body mass index and allograft function in pediatric renal transplantation. Pediatr Nephrol 2002; 7: 535-9.
Kelishadi R, Gheissari A, Bazookar N, Esmaeil M, Taslimi M, et al. Kidney function in obese adolescents with or without metabolic syndrome in a nationally-representative sample of pediatric population: First report from the Middle East and North Africa: The CASPIAN-III Study: A Case-Control Study. J Res Med Sci. 2013;18: 178-83.
Chen H, Li S, Chen H, Wang Q, Li L, Liu Z. Obesity-related glomerulopathy in China: a case series of 90 patients. Am J Kidney Dis. 2008; 52: 58-65.
Bonnet F, Deprele C, Sassolas A, Moulin P, Alamartine E, Berthezène F, et al. Excessive body weight as a new independent risk factor for clinical and pathological progression in primary IgA nephritis. Am J Kidney Dis. 2001; 37: 720-7.
Kataoka H, Ohara M, Shibui K, Sato M, Suzuki T, Amemiya N, et al. Overweight and obesity accelerate the progression of IgA nephropathy: prognostic utility of a combination of BMI and histopathological parameters. Clin Exp Nephrol. 2012; 16: 706 – 12.
Shimamura t. Focal glomerulosclerosis in obese Zucker rats and prevention of its development. Kidney Int .1983; 24: 5259-62.
Yoshikawa Y, Yamasaki K. Renal lesions of hyperlipidemic Imai rats: A spontaneous animal model of focal glomerulosclerosis. Nephon 1991; 59: 471 – 6.
Sartori C, Scherrer U. Insulin, nitric oxide and the sympathetic nervous system: at the crossroads of metabolic and cardiovascular regulation. J Hypertens 1999; 17: 1517-25.
El-Atat F, Stas S, McFarlane S, Sowers J. The relationship between hyperinsulinemia, hypertension and progressive renal disease. J Am Soc Nephrol. 2004; 15: 2816-27.
Ruster C, Wolf G. Renin-angiotensin-aldosterone system and progression of renal disease. J Am Soc Nephrol. 2006; 17: 2985-91.
Morrisey K, Evans R, Wakefield L, Phillips A. Translational regulation of renal proximal tubular epithelial cell transforming growth factor-beta1 generation by insulin. Am J Pathol. 2001; 159: 1905-15.
Wang S, Denichilo M, Brubaker C, Hirschberg R. Connective tissue growth factor in tubulointerstitial injury of diabetic nephropathy. Kidney Int. 2001; 60: 96-105.
Schelling J, Sedor J. The metabolic syndrome as a risk factor for chronic kidney disease: more than a fat chance? J Am Soc Nephrol. 2004; 15: 2773-4.
Spoto B, Zoccali C. Spleen IL-10, a key player in obesity-driven renal risk. Nephrol Dial Transplant. 2013;28:1061-4.
Pasceri V, Willerson J, Yeh E. Direct proinflammatory effect of C-reactive protein on human endothelial cells. Circulation 2000; 102: 2165-2168.
Pasceri V, Chang JS, Willerson J, Yeh E. Modulation of C-reactive protein-mediated monocyte chemoattractant protein-1 induction in human endothelial cells by anti-atherosclerosis drugs. Circulation 2001; 103: 2531-2534.
Fu C, Lee I, Sheu W, Lee W, Liang K, et al. The levels of circulating and urinary monocyte chemoattractant protein-1 are associated with chronic renal injury in obese men. Clin Chim Acta. 2012;413:1647-51.
Berlin de Chantemele E, Mintz J, Rainey W, Stepp D. Impact of leptin-mediated sumpatho-activation on cardiovascular function in obese mice. Hypertension. 2011; 58:271-9.
Gunta S, Mak R. Is obesity a risk factor for chronic kidney disease in children? Pediatr Nephrol. 2013; 28:1949-56.
Facchini F, Humphreys M, DoNascimento C, Abbasi F, Reaven G. Relation between insulin resistance and plasma concentrations of lipid hydroperoxides, carotenoids, and tocopherols. Am J Clin Nutr. 2000; 72: 776-9.
Oberg B, McMenamin E, Lucas F, Mc-Monagle E, Morrow J, Ikizler T, et al. Increased prevalence of oxidant stress and inflammation in patients with moderate to severe chronic kidney disease. Kidney Int. 2004; 65: 1009-16.
Bagby S. Obesity-initiated metabolic syndrome and the kidney: A recipe for chronic kidney disease? J Am Soc Nephrol. 2004;15:2775-91.
Thomas M, Harris K, Walls J, Furness P, Brunskill N. Fatty acids exacerbate tubulointerstitial injury in proteinoverload proteinuria. Am J Physiol Renal Physiol; 2002;283:F640-7.
Luttikhuis O, Baur L, Jansen H, Shrewsbury V, O’Malley C, Stolk R, et al. Interventions for treating obesity in children. Cochrane Database Syst Rev 2009; 1: CD001872.
Freemark M. Pharmacotherapy of childhood obesity: an evidence-based, conceptual approach. Diabetes Care 2007; 30: 395-402.
Mechanick J, Kushner R, Sugerman H, Gonzalez-Campoy M, Collazo-Clavell M, Guven S, et al American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Endocr Pract. 2008; 14: 1-83.
Amann K, Benz K. Structural renal changes in obesity and diabetes. Semin Nephrol. 2013; 33: 23-33.
Navaneethan S, Yehnert H, Moustarah F, Schreiber M, Schauer P, Beddhu S. Weight loss interventions in chronic kidney disease: a systematic review and meta-analysis. Clin J Am Soc Nephrol. 2009; 4: 1565-74.
Afshinnia F, Wilt T, Duval S, Esmaeili A, Ibrahim H. Weight loss and proteinuria: systematic review of clinical trials and comparative cohorts. Nephrol Dial Transplant. 2010; 25: 1173-83.
Enlaces refback
- No hay ningún enlace refback.