¿Aún no está registrado?

Cree su cuenta. Regístrese en Elsevier y obtendrá: información relevante, máxima actualización y promociones exclusivas.

Registrarme ahora
Ayuda - - Regístrese - Teléfono 902 888 740
Buscar en

Indexada en:



  • SCImago Journal Rank (SJR):0,11
  • Source Normalized Impact per Paper (SNIP):0,189
Hipertensión 2008;25:61-9 - DOI: 10.1016/S1889-1837(08)71738-0
Relación entre obesidad y desarrollo de insuficiencia renal
Relationship between obesity and development of kidney failure
E. Morales Ruiz, , M. Praga Terente
Servicio de Nefrología. Hospital Doce de Octubre. Madrid. España
Recibido 20 noviembre 2006, Aceptado 18 junio 2007

The incidence of obesity-related glomerulopathy has been reaching tremendous proportions over the last decade. The most frequently found lesion in kidney biopsies of obese patients with proteinuria is focal segmental glomerulosclerosis. Different epidemiological studies have demonstrated that obesity is an important risk factor for the development of proteinuria and renal failure in the normal population. The mechanisms by which obesity may induce proteinuria are unknown. However, there is evidence that points towards the participation of hemodynamic, hyperlipidemic factors and an increase of vasoactive and fibrogenic substances, which include angiotensin II, insulin, leptin and growth transforming factor-beta. Weight loss produces a marked reduction of the renin-angiotensin- aldosterone system. Body mass index increase is a risk factor for the development of proteinuria of kidney failure in patients with decreased functioning kidney mass (nephrectomized or renal agenesis). Although the angiotensin converting enzyme inhibitors have demonstrated a striking favorable influence, only temporally, weight loss produces a decrease in proteinuria in chronic proteinuric nephropathies of any disease. Prevention and treatment of obesity should be a primary objective within diabetic and no-diabetic patients with chronic kidney disease.

Palabras clave
obesidad, proteinuria, hiperfiltración, glomeruloesclerosis focal
Key words
obesity, proteinuria, hyperfiltration, focal glomeruloesclerosis
El Texto completo solo está disponible en PDF
J.R. Weisinger,R.L. Kempson,F.L. Eldridge,R.S. Swenson
The nephrotic syndrome: A complication of massive obesity
Ann Intern Med, 81 (1974), pp. 440-447
R.R. Verani
Obesity-associated focal segmental glomerulosclerosis: pathological features of the lesions and relationship with cardiomegaly and hyperlipidemia
Am J Kidney Dis, 20 (1992), pp. 629-634
N. Kambham,G. Markowitz,A.M. Valeri,J. Lin,V. D’Agati
Obesity-related glomerulopathy: an emerging epidemic
C.S. Fox,M.G. Larson,E.P. Leip,B. Culleton,P.W. Wilson,D. Levy
Predictors of new-onset kidney disease in a community- based population
A. Must,J. Spadano,E.H. Coakley,A.E. Field,G. Colditz,W.H. Dietz
The disease burden associated with overweight and obesity
JAMA, 282 (1999), pp. 1523-1529
C.Y. Hsu,C.E. McCulloch,C. Iribarren,J. Darbinian,A.S. Go
Body mass index and risk for end-stage renal disease
Ann Intern Med, 144 (2006), pp. 21-28
R.P. Gelber,T. Kurth,A.T. Kausz,J.E. Manson,J.E. Buring,A.S. Levey
Association between body mass index and CKD in apparently healthy men
Am J Kidney Dis, 46 (2005), pp. 871-880 http://dx.doi.org/10.1053/j.ajkd.2005.08.015
H. Kramer,A. Luke,A. Bidani,G. Cao,R. Cooper,D. McGee
Obesity and prevalent and incident CKD: the hipertensión detection and follow-up program
Am J Kidney Dis, 46 (2005), pp. 587-594 http://dx.doi.org/10.1053/j.ajkd.2005.06.007
M. Praga
Obesity- a neglected culprit in renal disease
Nephrol Dial Transplant, 17 (2002), pp. 1157-1159
B.L. Kasiske,J. Napier
Glomerular sclerosis in patients with massive obesity
Am J Nephrol, 5 (1985), pp. 45-50
M. Praga,E. Hernández,E. Morales,A. Pérez,M.A. Valero,M.A. Martínez
Clinical features and long term outcome of obesity-associated focal segmental glomeruloesclerosis
Nephrol Dial Transplant, 16 (2001), pp. 1790-1798
R.D. Adelman,I.G. Restaino,U.S. Alon,D.L. Blowey
Proteinuria and focal segmental glomeruloesclerosis in severy obese adolescents
J Pediatr, 138 (2001), pp. 481-485 http://dx.doi.org/10.1067/mpd.2001.113006
M. Praga,E. Morales,J.C. Herrero,Y. Revilla,I. Bello,R. Díaz-González
Disminución de masa renal funcionante y proteinuria
Nefrología, 18 (1998), pp. 17-22
M. Praga,B. Bornstein,A. Andrés,J. Arenas,A. Oliet,C. Montoyo
Nephrotic proteinuria without hypoalbuminemia: clinical characteristics and response to angiotensinconverting enzyme inhibition
Am J Kidney Dis, 17 (1991), pp. 330-338
M. Praga,E. Morales,J.C. Herrero,A. Pérez Campos,B. Domínguez-Gil,R. Alegre
Absence of hypoalbuminemia despite massive proteinuria in focal segmental glomerulosclerosis secondary to hyperfiltration
Am J Kidney Dis, 33 (1999), pp. 52-58
V. D’Agati
The many masks of focal segmental glomerulosclerosis
Kidney Int, 46 (1994), pp. 1223-1241
J.R. Henegar,S.A. Bigler,L.K. Henegar,S.C. Tyagi,J.E. Hall
Functional and structural changes in the kidney in the early stages of obesity
J Am Soc Nephrol, 12 (2001), pp. 1211-1217
R.D. Adelman
Obesity and renal disease
Curr Opin Nephrol Hypertens, 11 (2002), pp. 331-335
M. Praga,E. Morales
Obesity, proteinuria and progression of renal failure
Curr Opin Nephrol Hypertens, 15 (2006), pp. 481-486 http://dx.doi.org/10.1097/01.mnh.0000242172.06459.7c
J.E. Hall,M.W. Brandy,J.R. Henegar,E.W. Shek
Abnormal kidney function as a cause and a consequence of obesity hypertension
Clin Exp Pharmacol Physiol, 25 (1998), pp. 58-64
A. Chagnac,T. Weinstein,A. Korzets,E. Ramadan,J. Hirsch,U. Gafter
Glomerular hemodynamics in severe obesity
Am J Physiol, 278 (2000), pp. F817-F822
A. Chagnac,T. Weinstein,M. Herman,J. Hirsh,U. Gafter,Y. Ori
The effects of weight loss on renal function in patients with severe obesity
J Am Soc Nephrol, 14 (2003), pp. 1480-1486
J.E. Hall
The kidney, hypertension and obesity
C.A. Bickel,J.G. Verbalis,M.A. Knepper,C.A. Ecelbarger
Increased renal Na-K-ATPase, NCC, and beta-ENaC abundance in obese Zucker rats
Am J Physiol Renal Physiol, 281 (2001), pp. F639-F648
T. Jiang,Z. Wang,G. Proctor,S. Moskowitz,S.E. Liebman,T. Rogers
Diet-induced obesity in C57BL/6J mice causes increased renal lipid accumulation and glomeruloesclerosis via a sterol regulatory element-binding protein- 1c-dependent pathway
J Biol Chem, 280 (2005), pp. 32317-32325 http://dx.doi.org/10.1074/jbc.M500801200
S.P. Bagby
Obesity-initiated metabolic síndrome and the kidney: a recipe for chronic kidney disease?
J Am Soc Nephrol, 15 (2004), pp. 2775-2791 http://dx.doi.org/10.1097/01.ASN.0000141965.28037.EE
F.A. El-Atat,S.N. Stas,S.I. McFarlane,J.R. Sowers
The relationship between hiperinsulinemia, hipertensión and progressive renal disease
J Am Soc Nephrol, 15 (2004), pp. 2816-2827 http://dx.doi.org/10.1097/01.ASN.0000133698.80390.37
S. Blanco,M. Vaquero,C. Gómez-Guerrero,D. López,J. Egido,R. Romero
Potential role of angiotensina-converting enzyme inhibitors and statins on early podocyte damage in a model of type 2 diabetes mellitus, obesity and mild hypertension
Am J Hypertens, 18 (2005), pp. 557-565 http://dx.doi.org/10.1016/j.amjhyper.2004.10.034
S. Engeli,J. Bohnke,K. Gorzelniak,J. Janke,P. Schling,M. Bader
Weight loss and the renin-angiotensin-aldosterone system
R.B. De Paula,A.A. Da Silva,J.E. Hall
Aldosterone antagonism attenuates obesity-induced hypertension and glomerular hyperfiltration
M. Ehrhart-Bornstein,V. Lamounier-Zepter,A. Schraven,J. Langenbach,H.S. Willenberg,A. Barthel
Human adipocytes secrete mineralocorticoid-releasing factors
Proc Natl Acad Sci USA, 10 (2003), pp. 14211-14216
T.H. Hostetter,M. Ibrahim
Aldosterone in chronic kidney and cardiac disease
J Am Soc Nephrol, 14 (2003), pp. 2395-2401
J. Frystyk,C. Skjaerbaek,E. Vesto,S. Fisker,H. Orskov
Circulating levels of free insulin-like growth factors in obese subjects: the impact of type 2 diabetes
Diabetes Metab Res Rev, 15 (1999), pp. 314-322
C. Baylis,E.A. Atzpodien,G. Freshour,K. Engels
Peroxisome proliferator-activated receptor [gamma] agonist provides superior renal protection versus angiotensina-converting enzyme inhibition in a rat model of tipe 2 diabetes with obesity
J Pharmacol Exp Ther, 307 (2003), pp. 854-860 http://dx.doi.org/10.1124/jpet.103.055616
G. Wolf,A. Hamman,D.C. Han,U. Helmchen,F. Thaiss,F.N. Zyyadeh
Leptin stimulates proliferation and TGF-? expression in renal glomerular endothelial cells. Potential role in glomerulosclerosis
F.N. Ziyadeh,B.B. Hoffman,D.C. Hand,M.C. Iglesias-de la Cruz,S.W. Hong,M. Isono
Long-term prevention of renal insufficiency, excess matrix gene expression, and glomerular mesangial matrix expansion by treatment with monoclonal antitransforming growth factor-beta antibody in db/db diabetic mice
Proc Natl Acad Sci USA, 97 (2000), pp. 8015-8020 http://dx.doi.org/10.1073/pnas.120055097
F.T. Stevenson,C.M. Wheeldon,M.D. Gades,G.A. Kaysen,J.S. Stern,H. van Goor
Estrogen worsens incipient hypertryglyciridemic glomerular injury in the obese Zucker rat
M. Nangaku,Y. Izuhara,N. Usuda,R. Inagi,T. Shibata,S. Sugiyama
In a type 2 diabetic nephropathy rat model, the improvement of obesity by a low calorie diet reduces oxidative/carbonyl stress and prevents diabetic nephropathy
Nephrol Dial Transplant, 20 (2005), pp. 2661-2669 http://dx.doi.org/10.1093/ndt/gfi096
Y. Wu,Z. Liu,Z. Xiang,C. Zeng,Z. Chen,X. Ma
Obesity- related glomerulopathy: insights from gene expression profiles of the glomeruli derived from renal biopsy samples
Endocrinology, 147 (2006), pp. 44-50 http://dx.doi.org/10.1210/en.2005-0641
B.M. Brenner,T.W. Meyer,T.H. Hostetter
Dietary protein intake and the progressive nature of kidney disease: the role of hemodinamically mediated injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation and intrinsic renal disease
N Engl J Med, 307 (1982), pp. 652-659 http://dx.doi.org/10.1056/NEJM198209093071104
M. Praga
Sinergy of low nephron number and obesity: a new focus on hyperfiltration nephropathy
Nephrol Dial Transplant, 20 (2005), pp. 2594-2597 http://dx.doi.org/10.1093/ndt/gfi201
M. Praga,E. Hernández,J.C. Herrero,E. Morales,Y. Revilla,R. Díaz-González
Influence of obesity on the appearance of proteinuria and renal insufficienciy alter unilateral uninephrectomy
E. González,E. Gutiérrez,E. Morales,E. Hernández,A. Andres,I. Bello
Factors influencing the progresión of renal damage in patients with unilateral renal agenesis and remmant kidney
G.C. Curhan,W.C. Willet,E.B. Rimm,D. Spiegelman,A.L. Ascherio,M.J. Stampfer
Birth weight and adult hypertension, diabetes mellitus and obesity in US men
Circulation, 94 (1996), pp. 3246-3250
E. Morales,M.A. Valero,M. León,E. Hernández,M. Praga
Beneficial effects of weight loss in overweight patients with chronic proteinuric nephropathies
Am J Kidney Dis, 41 (2003), pp. 319-327 http://dx.doi.org/10.1053/ajkd.2003.50039
F.C. Soto,G. Higa-Sansone,J.B. Copley,M. Berho,C. Kennedy,E. LoMenzo
Renal failure, glomerulonephritis and morbid obesity: improvement after rapid weight loss following laparoscopic gastric by-pass
Obes Surg, 15 (2005), pp. 137-140 http://dx.doi.org/10.1381/0960892052993413
R. Palomar,G. Fernández-Fresnedo,A. Domínguez-Díez,M. López-Deogracias,F. Olmedo,A.L. Martín de Francisco
Effects of weight loss after biliopancreatic diversion on metabolism and cardiovascular profile
Obes Surg, 15 (2005), pp. 794-798 http://dx.doi.org/10.1381/0960892054222687
T.H. Jafar,C.H. Schmid,M. Landa,I. Giatras,R. Toto,G. Remuzzi
Angiotensin-converting enzyme inhibitors and progression of nondiabetic renal disease. A meta-analysis of patient-level data
Ann Intern Med, 135 (2001), pp. 73-87
M. Praga,E. Hernández,A. Andrés,M. León,L.M. Ruilope,J.L. Rodicio
Effects of body-weight loss and captopril treatment on proteinuria associated with obesity
Nephron, 70 (1995), pp. 35-41
Correspondencia: Servicio de Nefrología. Hospital Doce de Octubre. Avda. Andalucía, s/n. 28041 Madrid. España.
Copyright © 2008. Sociedad Espa??ola de Hipertension-Liga Espa??ola para la Lucha de la Hipertensi??n Arterial (SEH-LELHA)