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[Obesity in children and its relationship with chronic kidney disease]
Jessie Nallely Zurita-Cruz1, Miguel Ángel Villasís-Keever
1Servicio de Escolares y Adolescentes, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México. miguel.villasis@imss.gob.mx.
Insights
Obesity increasingly impacts kidney health, especially in children. Early weight management is crucial to prevent chronic kidney disease (CKD) and reduce future patient numbers.
Area of Science:
- Nephrology
- Pediatrics
- Metabolic Diseases
Background:
- Global rise in obesity and chronic kidney disease (CKD) observed in parallel.
- Obesity is linked to type 2 diabetes mellitus, hypertension, and reduced insulin sensitivity, directly impacting renal health.
- Growing evidence links increased Body Mass Index (BMI) to the development of End-Stage Renal Disease (ESRD).
Purpose of the Study:
- To review the impact of obesity on renal damage, with a focus on pediatric populations.
- To elucidate the pathophysiological mechanisms linking obesity to kidney disease.
- To highlight the importance of early intervention for weight management in preventing CKD.
Main Methods:
- Review of epidemiological studies and pathophysiological mechanisms.
- Focus on research concerning obesity and renal damage in both adult and pediatric populations.
- Analysis of intervention studies demonstrating the effects of weight loss on renal parameters.
Main Results:
- Reduced insulin sensitivity in obesity exacerbates renal damage through mechanisms like glomerular hyperfiltration, hypertrophy, and increased inflammation.
- Studies indicate that weight loss interventions can reduce proteinuria, lower blood pressure, and improve glomerular filtration rate.
- While adult data is extensive, pediatric data, though scarce, aligns with adult findings regarding obesity's detrimental effects on kidneys.
Conclusions:
- Obesity poses a significant threat to kidney health, particularly in children.
- Pathophysiological pathways driven by insulin resistance and inflammation contribute to obesity-related kidney damage.
- Proactive strategies to combat childhood obesity are essential for future CKD prevention.
Abstract:
In the last decades, obesity and chronic kidney disease (CKD) have increased worldwide, in parallel. This article focuses on the current issues of obesity on renal damage, with special emphasis on what happens at pediatric ages. While obesity has been linked closely with type 2 diabetes mellitus and hypertension, reduced insulin sensitivity is a direct mechanism for renal damage. The pathophysiologic mechanisms on renal damage include glomerular hyperfiltration and hypertrophy, hypercellularity and broadening of the mesangial regions, while the lack of sensitivity to insulin increases the effects of angiotensin II, exacerbates proteinuria and induces the production of inflammatory cytokines. Many epidemiological studies have documented the relationship of increased BMI with the development of ERC, but most of these studies have been conducted in adults. In children, the information is scarce, but is consistent with findings in adults. In contrast, there are studies which show that interventions aimed to improve weight loss and limit renal damage and proteinuria is reduced, the blood pressure and glomerular filtration rate. Allthe above make us think on the need to improve efforts to reduce the prevalence of obesity from the early stages of life, which could reduce the number of patients with CKD in the future.
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