Review Article

Kidney Disease in the Obese Patient

Authors: M. Tarek Naguib, MD

Abstract

Obesity constitutes a strong risk factor for the development of chronic kidney disease. This review examines the epidemiology, clinicopathologic presentation, and proposed mechanisms for chronic kidney disease in the obese patient. Obesity-associated nephropathy displays a continuum that evolves from glomerulomegaly to glomerulosclerosis and from mild to severe proteinuria in the absence of significant edema and hypoalbuminemia. The disease may well progress into end-stage renal disease unless weight management strategies are used. The renal effects of different obesity treatments are reviewed. Interestingly, the reversibility of the disease throughout out most of its stages highlights the benefit of weight loss strategies in this population. Nephrolithiasis as it relates to obesity also is examined in addition to other pertinent comorbidities in obesity such as incontinence, calciphylaxis, and the renal complications of bariatric procedures.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Ogden CL, Carroll MD, Kit BK, et al. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA 2014;311:806-814.
 
2. Kramer CK, Zinman B, Retnakaran R. Are metabolically healthy overweight and obesity benign conditions? A systematic review and meta-analysis. Ann Intern Med 2013;159:758-769.
 
3. Fox CS, Larson MG, Leip EP, et al. Predictors of new-onset kidney disease in a community-based population. JAMA 2004;291:844-850.
 
4. Kramer H, Luke A, Bidani A, et al. Obesity and prevalent and incident CKD: the Hypertension Detection and Follow-Up Program. Am J Kidney Dis 2005;46:587-594.
 
5. Hsu CY, McCulloch CE, Iribarren C, et al. Body mass index and risk for end-stage renal disease. Ann Intern Med 2006;144:21-28.
 
6. Navaneethan SD, Kirwan JP, Arrigain S, et al. Overweight, obesity and intentional weight loss in chronic kidney disease: NHANES 1999-2006. Int J Obes (Lond) 2012;36:1585-1590.
 
7. Grubbs V, Lin F, Vittinghoff E, et al. Body mass index and early kidney function decline in young adults: a longitudinal analysis of the CARDIA (Coronary Artery Risk Development in Young Adults) study. Am J Kidney Dis 2014;63:590-597.
 
8. Berthoux F, Mariat C, Maillard N. Overweight/obesity revisited as a predictive risk factor in primary IgA nephropathy. Nephrol Dial Transplant 2013;28(Suppl 4):iv160-iv166.
 
9. Agarwal R, Bills Je, Light RP. Diagnosing obesity by body mass index in chronic kidney disease: an explanation for the “obesity paradox?”. Hypertension 2010;56:893-900.
 
10. Zoccali C, Torino C, Tripepi G, et al. Assessment of obesity in chronic kidney disease: what is the best measure? Curr Opin Nephrol Hypertens 2012;21:641-646.
 
11. Johansen KL, Dalrymple LS, Delgado C, et al. Association between body composition and frailty among prevalent hemodialysis patients: a US Renal Data System special study. J Am Soc Nephrol 2014;25:381-389.
 
12. Serra A, Romero R, Lopez D, et al. Renal injury in the extremely obese patients with normal renal function. Kidney Int 2008;73:947-955.
 
13. Kambham N, Markowitz GS, Valeri AM, et al. Obesity-related glomerulopathy: an emerging epidemic. Kidney Int 2001;59:1498-1509.
 
14. Praga M, Hernandez E, Morales E, et al. Clinical features and long-term outcome of obesity-associated focal segmental glomerulosclerosis. Nephrol Dial Transplant 2001;16:1790-1798.
 
15. Chagnac A, Weinstein T, Herman M, et al. The effects of weight loss onrenal function in patients with severe obesity. J Am Soc Nephrol 2003;14:1480-1486.
 
16. Yamahara K, Kume S, Koya D, et al. Obesity-mediated autophagy insufficiency exacerbates proteinuria-induced tubulointerstitial lesions. J Am Soc Nephrol 2013;24:1769-1781.
 
17. Taylor EN, Stampfer MJ, Curhan GC. Obesity, weight gain, and the risk of kidney stones. JAMA 2005;293:455-462.
 
18. Eisner BH, Eisenberg ML, Stoller ML. Relationship between body mass index and quantitative 24-hour urine chemistries in patients with nephrolithiasis. Urology 2010;75:1289-1293.
 
19. Zuckerman JM, Assimos DG. Hypocitraturia: pathophysiology and medical management. Rev Urol 2009;11:134-144.
 
20. Pigna F, Sakhaee K, Adams-Huet B, et al. Body fat content and distribution and urinary risk factors for nephrolithiasis. Clin J Am Soc Nephrol 2014;9:159-165.
 
21. Soldati L, Bertoli S, Terranegra , et al. Relevance of Mediterranean diet and glucose metabolism for nephrolithiasis in obese subjects. J Transl Med 2014;12:34.
 
22. Sorensen MD, Chi T, Shara NM, et al. Activity, energy intake, obesity, and the risk of incident kidney stones in postmenopausal women: a report from the Women’s Health Initiative. J Am Soc Nephrol 2014;25:362-369.
 
23. Grethen E, McClintock R, Gupta CE, et al. Vitamin D and hyperparathyroidism in obesity. J Clin Endocrinol Metab 2011;96:1320-1326.
 
24. Subak LL, Richter HE, Hunskaar S. Obesity and urinary incontinence: epidemiology and clinical research update. J Urol 2009;182(6 Suppl):S2-S7.
 
25. Richter HE, Creasman JM, Myers DL, et al. Urodynamic characterization of obese women with urinary incontinence undergoing a weight loss program: the Program to Reduce Incontinence by Diet and Exercise (PRIDE) trial. Int Urogynecol J Pelvic Floor Dysfunct 2008;19:1653-1658.
 
26. Wing RR, Creasman JM, West DS, et al. Improving urinary incontinence in the overweight and obese women through modest weight loss. Obstet Gynecol 2010;116(2 Pt 1):284-292.
 
27. Subak LL, Marinilli Pinto A, Wing RR, et al. Decrease in urinary incontinence management costs in women enrolled in a clinical trial of weight loss to treat urinary incontinence. Obstet Gynecol 2012;120(2 Pt 1):277-283.
 
28. Munavalli G, Reisenauer A, Moses M, et al. Weight loss-induced calciphylaxis: potential role of matrix metalloproteinases. J Dermatol 2003;30:915-919.
 
29. Bleyer AJ, Choi M, Igwemezie B, et al. A case control study of proximal calciphylaxis. Am J Kidney Dis 1998;32:376-383.
 
30. Kalajian AH, Malhotra PS, Callen JP, et al. Calciphylaxis with normal renal and parathyroid function: not as rare as previously believed. Arch Dermatol 2009;145:451-458.
 
31. Derosa G, Ferrari I, D’Angelo A, et al. Matrix metalloproteinase-2 and -9 levels in obese patients. Endothelium 2008;15:219-224.
 
32. Grassi G, Seravalle G, Cattaneo BM, et al. Sympathetic activation in obese normotensive subjects. Hypertension 1995;25(4 Pt 1):560-563.
 
33. Banfi C, Cavalca V, Veglia F. Neurohormonal activation is associated with increased levels of plasma matrix metalloproteinase-2 in human heart failure. Eur Heart J 2005;26:481-488.
 
34. Shen WW, Chen HM, Chen H, et al. Obesity-related glomerulopathy: body mass index and proteinuria. Clin J Am Soc Nephrol 2010;5:1401-1409.
 
35. Morales E, Valero MA, Leon M, et al. Beneficial effects of weight loss in overweight patients with chronic proteinuric nephropathies. Am J Kidney Dis 2003;41:319-327.
 
36. Friedman AN, Chambers M, Kamendulis LM, et al. Short-term changes after a weight reduction intervention in advanced diabetic nephropathy. Clin J Am Soc Nephrol 2013;8:1892-1898.
 
37. Chauhan V, Vaid M, Gupta M, et al. Metabolic, renal, and nutritional consequences of bariatric surgery: implications for the clinician. South Med J 2010;103:775-783.
 
38. Courcoulas AP, Christian NJ, Belle SH, et al. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA 2013;310:2416-2425.
 
39. Goldfarb S. Disorders of divalent ions, renal bone disease, and nephrolithiasis. NephSAP 2012;9:321-323.
 
40. Williams HE. Oxalic acid and the hyperoxaluric syndromes. Kidney Int 1978;13:410-417.
 
41. Patel BN, Passman CM, Fernandez A, et al. Prevalence of hyperoxaluria after bariatric surgery. J Urol 2009;181:161-166.
 
42. Semins MJ, Matlaga BR, Shore AD, et al. The effect of gastric banding on kidney stone disease. Urology 2009;74:746-749.
 
43. Penniston KL, Kaplon DM, Gould JC, et al. Gastric band placement for obesity is not associated with increase urinary risk of urolithiasis compared to bypass. J Urol 2009;182:2340-2346.
 
44. Chen T, Godebu E, Horgan S, et al. The effect of restrictive bariatric surgery on urolithiasis. J Endourol 2013;27:242-244.
 
45. Asplin JR, Coe FL. Hyperoxaluria in kidney stone formers treated with modern bariatric surgery. J Urol 2007;177:565-569.
 
46. Nasr SH, D’Agati VD, Said SM, et al. Oxalate nephropathy complicating Roux-en-Y gastric bypass: an underrecognized cause of irreversible renal failure. Clin J Am Soc Nephrol 2008;3:1676-1683.
 
47. De Oliveira LD, Diniz MT, de Fatima HS, Diniz M, et al. Rhabdomyolysis after bariatric surgery by Roux-en-Y gastric bypass: a prospective study. Obes Surg 2009;19:1102-1107.
 
48. Filis D, Daskalakis M, Askoxylakis I, et al. Rhabdomyolysis following laparoscopic gastric bypass. Obes Surg 2005;15:1496-1500.
 
49. Bostanjian D, Anthone GJ, Hamoui N, et al. Rhabdomyolysis of gluteal muscles leading to renal failure: a portenially fatal complication of surgery in the morbidly obese. Obes Surg 2003;13:302-305.
 
50. De Freitas Carvalho DA, Valezi AC, de Brito EM, et al. Rhabdomyolysis after bariatric surgery. Obes Surg 2006;16:740-744.
 
51. Thakar CV, Kharat V, Blanck S, et al. Acute kidney injury after gastric bypass surgery. Clin J Am Soc Nephrol 2007;2:426-430.