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Review article: Adiponectin: its role in kidney disease
Yvonne Y Shen1, Philip W Peake, John A Charlesworth
1Department of Nephrology, Prince of Wales Hospital, University of New South Wales, Sydney, New South Wales, Australia. yshen@bigpond.com
Nephrology (Carlton, Vic.)
|January 14, 2009
Summary
Adiponectin, a protein with anti-inflammatory and insulin-sensitizing effects, is elevated in kidney disease. Its levels and receptor expression change after transplantation, and urinary adiponectin may play a role in kidney disease.
Area of Science:
- Endocrinology and Metabolism
- Nephrology
- Vascular Biology
Background:
- Adiponectin exhibits insulin-sensitizing, anti-atherogenic, and anti-inflammatory properties.
- Despite these beneficial effects, adiponectin levels are paradoxically high in end-stage kidney disease (ESKD) patients who have high rates of insulin resistance and vascular disease.
- Adiponectin circulates in various isoforms, with the high-molecular-weight (HMW) isoform considered the most potent in sensitizing insulin.
Purpose of the Study:
- To review the structure, function, and metabolism of adiponectin in the context of kidney disease.
- To explore the potential role of adiponectin and its receptors in the uraemic environment and post-kidney transplantation.
- To discuss the significance of urinary adiponectin in proteinuric kidney diseases.
Main Methods:
- Review of existing literature on adiponectin, its receptors, and their role in kidney disease.
- Analysis of adiponectin and AdipoR expression in peripheral blood mononuclear cells before and after kidney transplantation.
- Detection and characterization of adiponectin in urine samples from patients with proteinuric kidney disease.
Main Results:
- The adiponectin/receptor system appears upregulated in ESKD as a counter-regulatory response to the uraemic milieu.
- Adiponectin and AdipoR mRNA expression decrease in peripheral blood mononuclear cells post-kidney transplantation, potentially due to immunosuppression or improved renal function.
- Adiponectin is found in urine, particularly the intact HMW isoform, in patients with proteinuric kidney disease, suggesting a potential role for urinary adiponectin.
Conclusions:
- The adiponectin system is dysregulated in kidney disease, with complex changes observed in ESKD and after transplantation.
- Urinary adiponectin, especially the HMW isoform, may serve as a biomarker or have a functional role in proteinuric kidney diseases.
- Further research is needed to fully elucidate the role of adiponectin and its isoforms in the pathogenesis and progression of kidney disease and its complications.
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