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Dtsch Med Wochenschr 2017; 142(19): 1466-1472
DOI: 10.1055/s-0043-110659
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Übergewicht und Nierenerkrankungen – renale Risiken einer „Epidemie“

Obesity and kidney disease – renal consequences of an „epidemic“
Helmut Schiffl
,
Susanne Maria Lang
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Publication History

Publication Date:
22 September 2017 (online)

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Abstract

Overweight and obesity are widespread in the German population, affecting not only adults but also a significant number of children and adolescents. The risk to develop chronic kidney disease is markedly increased in overweight or adipose children, adolescents and adults.

Overweight and obesity induced risk factors have a direct impact on the development of chronic renal disease (obesity-associated focal segmental glomerulosclerosis). They accelerate the progression of coexistent nephropathies (diabetic or hypertensive nephropathy, primary glomerulonephritides) and are independent risk factors for the development of acute kidney injury in critically ill patients.

Obesity induced nephropathies are basically preventible. Marked weight reduction, normoglycemia and control of hypertension may contribute to an improved glomerular filtration rate and/or reduced proteinuria in early stages of renal damage.

The prevalence of kidney diseases in Germany is 13 % and estimated 80 000 patients need renal replacement therapy. In order to avoid a further rapid increase in numbers, preventive measures should be enforced more rigorously.

It is necessary to raise the awareness of the negative consequences of obesity in the general public, to motivate the public to adopt a healthier lifestyle and to install nephrological surveillance to contain the obesity „epidemic“.

Übergewicht ist in Deutschland inzwischen der Normalfall, manche sprechen bereits von einer Epidemie. Damit steigt auch das Risiko für chronische Nierenerkrankungen. Ihre Pathophysiologie, Diagnose und mögliche Therapieansätze werden hier kurz umrissen. Das allerwichtigste ist allerdings, wie so oft: die Prävention.

Schlüsselwörter

Adipositas - renale Syndrome - Prävention - akutes Nierenversagen

Key words

obesity - renal syndromes - prevention - acute kidney injury
 

  • Literatur

  • 1 WHO. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. WHO Technical Report Series; 2000 894. 1-252
    PubMedGoogle Scholar
  • 2 Mensink GBM, Schienkiewitz A, Haftenberger M. et al. Overweight and obesity in Germany. Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz 2013; 56: 786-794
    CrossrefPubMedGoogle Scholar
  • 3 Kurth BM, Schaffrath RosarioA. The prevalence of overweight and obese children and adolescents living in Germany. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz 2007; 50: 736-743
    CrossrefPubMedGoogle Scholar
  • 4 Grover SA, Kaouache M, Rempel P. et al. Years of life lost and healthy life-years lost from diabetes and cardiovascular disease in overweight and obese people: a modelling study. Lancet Diabetes & Endocrinol 2015; 3: 114-122
    PubMedGoogle Scholar
  • 5 Klassen A, Bahner U, Sebekova K. et al. The importance of overweight and obesity for the development and progression of renal diseases. Dtsch Med Wochenschr 2004; 129: 579-582
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Hsu CY, McCulloch CE, Iribarren C. et al. Body mass index and risk for end-stage renal disease. Ann Intern Med 2006; 144: 21-28
    CrossrefPubMedGoogle Scholar
  • 7 Ku E, Glidden DV, Hsu CY. et al. Association of body mass index with patient-centered outcomes in children with ESRD. J Am Soc Nephrol 2016; 27: 551-558
    CrossrefPubMedGoogle Scholar
  • 8 Othman M, Kawar B, El NahasAM. Influence of obesity on progression of non-diabetic chronic kidney disease: a retrospective cohort study. Nephron Clin Pract 2009; 113: c16-c23
    CrossrefPubMedGoogle Scholar
  • 9 Praga M, Morales E. The fatty kidney: Obesity and renal disease. Nephron 2016; DOI: 10.1159/000447674.
    PubMedGoogle Scholar
  • 10 D'Agati VD, Chagnac A, de Vries AP. et al. Obesity-related glomerulopathy: clinical and pathologic characteristics and pathogenesis. Nat Rev Nephrol 2016; 12: 453-471
    CrossrefPubMedGoogle Scholar
  • 11 Amann K, Benz K. Structural renal changes in obesity and diabetes. Semin Nephrol 2013; 33: 23-33
    CrossrefPubMedGoogle Scholar
  • 12 Hashimoto Y, Tanaka M, Okada H. et al. Metabolically healthy obesity and risk of incident CKD. Clin J Am Soc Nephrol 2015; 10: 578-583
    CrossrefPubMedGoogle Scholar
  • 13 Navarro DíazM. Consequences of morbid obesity on the kidney. Where are we going? . Clin Kidney J 2016; 20: 1
    PubMedGoogle Scholar
  • 14 Kwakernaak AJ, Toering TJ, Navis G. Body mass index and body fat distribution as renal risk factors: a focus on the role of renal haemodynamics. Nephrol Dial Transplant 2013; 28 (04) iv42-iv49
    CrossrefPubMedGoogle Scholar
  • 15 Szeto HH, Liu S, Soong Y. et al. Protection of mitochondria prevents high-fat diet-induced glomerulopathy and proximal tubular injury. Kidney Int 2016; 90: 997-1011
    CrossrefPubMedGoogle Scholar
  • 16 Tang J, Yan H, Zhuang S. Inflammation and oxidative stress in obesity-related glomerulopathy. Int J Nephrol 2012; 2012 DOI: 608397.
    PubMedGoogle Scholar
  • 17 Serra A, Esteve A, Navarro-Diaz M. et al. Long-term normal renal function after drastic weight reduction in patients with obesity-related glomerulopathy. Obes Facts 2015; 8: 188-199
    CrossrefPubMedGoogle Scholar
  • 18 Li K, Zou J, Ye Z. et al. Effects of bariatric surgery on renal function in obese patients: a systematic review and meta analysis. PloS one 2016; 11: e0163907
    CrossrefPubMedGoogle Scholar
  • 19 Fowler SM, Kon V, Ma L. et al. Obesity-related focal and segmental glomerulosclerosis: normalization of proteinuria in an adolescent after bariatric surgery. Pediatr Nephrol 2009; 24: 851-855
    CrossrefPubMedGoogle Scholar
  • 20 Cohen JB, Stephens-Shields AJ, Denburg MR. et al. Obesity, Renin-Angiotensin system blockade and risk of adverse renal outcomes: a population-based cohort study. Am J Nephrol 2016; 43: 431-440
    CrossrefPubMedGoogle Scholar
  • 21 Schiffl H, Lang SM. Obesity, acute kidney injury and outcome of critical illness. Int Urol Nephrol 2016; DOI: 10.1007/s11255–016–1451–4.
    PubMedGoogle Scholar
  • 22 Goh R, Darvall J, Wynne R. et al. Obesity prevalence and associated outcomes in cardiothoracic patients: a single-centre experience. Anaesthesia and Intensive Care 2016; 44: 77-84
    PubMedGoogle Scholar
  • 23 Danziger J, Chen KP, Lee J. et al. Obesity, acute kidney injury, and mortality in critical illness. Crit Care Med 2016; 44: 328-334
    PubMedGoogle Scholar
  • 24 Bucaloiu ID, Perkins RM, DiFilippo W. et al. Acute kidney injury in the critically ill, morbidly obese patient: diagnostic and therapeutic challenges in a unique patient population. Crit Care Clin 2010; 26: 607-624
    CrossrefPubMedGoogle Scholar
  • 25 Schiffl H, Lang SM, Fischer R. Long-term outcome of survivors of ICU acute kidney injury requiring renal replacement therapy: a ten year prospective cohort study. Clin Kidney J 2012; 5: 297-302
    CrossrefPubMedGoogle Scholar
  • 26 Druml W, Metnitz B, Schaden E. et al. Impact of body mass on incidence and prognosis of acute kidney injury requiring renal replacement therapy. Intensive Care Med 2010; 36: 1221-1228
    CrossrefPubMedGoogle Scholar
  • 27 Chao CT, Wu VC, Tsai HB. et al. Impact of body mass on outcomes of geriatric postoperative acute kidney injury patients. Shock (Augusta, Ga) 2014; 41: 400-405
    CrossrefPubMedGoogle Scholar
  • 28 Meersch M, Zarbock A. Renal protection in the 21st century. Current Opinion in Critical Care 2016; 22: 554-559
    CrossrefPubMedGoogle Scholar