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MASLD: Lipotoxicity and Imaging Parallels from Liver Steatosis to Kidney Injury
Sarmis Marian Săndulescu1, Denisa Ștefania Ghiga2, Diana Rodica Tudorașcu3
1Department of Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
Abstract:
Metabolic dysfunction-associated steatotic liver disease (MASLD) is recognized as a systemic condition that is associated with an increased prevalence of chronic kidney disease (CKD), independent of classical risk factors. This review explores MASLD and metabolic kidney dysfunction, emphasizing lipotoxicity, emerging biomarkers, and liver-kidney fat imaging techniques. Renal fat is discussed as an ectopic lipid depot that may contribute to kidney vulnerability in the same cardiometabolic milieu as MASLD. In this context, lipotoxicity, a phenomenon intensively studied in MASLD, can affect multiple nephron segments, promoting fibrosis and, ultimately, CKD. Hepatokines may support the concept of a liver-kidney metabolic axis, but human data remain limited. Tubular biomarkers show promise for detecting early renal injury, but lack validation in large populations. Hepatic steatosis is quantified through multiple validated imaging techniques such as ultrasound, elastography, and magnetic resonance imaging (MRI). In contrast, renal fat imaging studies are limited and heterogeneous, and still lack standardization. In MASLD, an integrated hepatorenal assessment is warranted to capture the full burden of the disease.
Insights
Metabolic dysfunction-associated steatotic liver disease (MASLD) is linked to chronic kidney disease (CKD). This review highlights lipotoxicity, biomarkers, and imaging for assessing kidney fat and MASLD-related renal dysfunction.
Area of Science:
- Nephrology
- Hepatology
- Metabolic Diseases
Background:
- Metabolic dysfunction-associated steatotic liver disease (MASLD) is a systemic condition.
- MASLD is independently associated with an increased prevalence of chronic kidney disease (CKD).
- Understanding the interplay between liver fat and kidney health is crucial.
Purpose of the Study:
- To review the relationship between MASLD and metabolic kidney dysfunction.
- To emphasize the roles of lipotoxicity, biomarkers, and imaging techniques.
- To explore the concept of renal fat as an ectopic lipid depot contributing to kidney vulnerability.
Main Methods:
- Literature review focusing on MASLD, CKD, lipotoxicity, biomarkers, and imaging.
- Analysis of current understanding of liver-kidney metabolic interactions.
- Evaluation of diagnostic and assessment tools for hepatic and renal fat.
Main Results:
- Lipotoxicity in MASLD can impact nephron segments, promoting fibrosis and CKD.
- Emerging tubular biomarkers show potential for early renal injury detection.
- Validated imaging techniques exist for hepatic steatosis, but renal fat imaging lacks standardization.
Conclusions:
- An integrated hepatorenal assessment is necessary for MASLD.
- Further research is needed on the liver-kidney metabolic axis and renal fat imaging.
- Addressing MASLD is key to managing associated kidney dysfunction.
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