Obesity and chronic kidney disease. A look from the pathophysiological mechanisms.

Narrative review.

Abstract

Introduction: Chronic kidney disease associated with obesity (CKD-WO) has increased in prevalence in recent decades. It is characterized by excess adipocytic hormonal imbalances (adipokines), deregulation of the energy balance system, and imbalances in metabolic homeostasis.

Purpose of the review: The objective is to outline the different pathophysiological mechanisms' role in developing functional or anatomical kidney disease in obese patients. We look for updated reports that include the best survival results for patients with CKD.

Recent findings: We currently know that CKD-WO has a chronic pro-inflammatory behavior. Obesity and overweight are associated with hemodynamic, structural, and histopathological alterations in the kidney and metabolic and biochemical alterations that predispose to kidney disease, even when renal function and conventional tests are normal.

Conclusions: We classify CKD-WO in Type 1: Obesity and potentially reversible functional alterations. Type 2: Obesity and potentially non-reversible histopathological structural alterations (includes glomerulopathy associated with obesity and focal segmental glomerulosclerosis). Type 3: Obesity-related to chronic diseases (diabetes, hypertension, pulmonary hypertension, heart failure). Type 4: Obesity in the patient with renal function replacement therapy.