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Vol. 31. Núm. 4.Julio 2011
Páginas 379-504
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Vol. 31. Núm. 4.Julio 2011
Páginas 379-504
DOI: 10.3265/Nefrologia.pre2011.May.10963
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Obesidad y enfermedad renal crónica
Obesity and chronic kidney disease
G.. Eknoyana
a Renal Section, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA,
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La obesidad está relacionada con la aparición temprana de glomerulomegalia, las alteraciones hemodinámicas del riñón hiperfiltrante y el aumento de la albuminuria, síntomas que son reversibles con una pérdida de peso. Por el contrario, las lesiones patológicas de la glomeruloesclerosis focal y segmentaria se desarrollan en modelos experimentales de obesidad mantenida y se observan en pacientes con obesidad mórbida que presentan proteinuria masiva. Además, diferentes estudios observacionales, transversales y longitudinales han demostrado que la obesidad supone un factor de riesgo independiente de la aparición, el empeoramiento, y la escasa respuesta al tratamiento de la enfermedad renal crónica (ERC), incluso después de ajustar por variables de confusión, incluido el síndrome metabólico, la diabetes y la hipertensión, las principales causas de la enfermedad renal crónica. En los pacientes con enfermedad renal crónica que presentan sobrepeso y obesidad debe considerarse la instauración precoz de una dieta para reducir peso y la cirugía bariátrica, en caso de ser necesaria.

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Enfermedad renal
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Obesity is associated with the early onset of glomerulomegaly, hemodynamic changes of a hyperfiltering kidney, and increased albuminuria, which are potentially reversible with weight loss. However, pathologic lesions of focal segmental glomerulosclerosis develop in experimental models of sustained obesity, and are observed in morbidly obese humans presenting with massive proteinuria. In addition, several observational, cross sectional and longitudinal studies document that obesity is as an independent risk factor for the onset, aggravated course, and poor outcomes of chronic kidney disease, even after adjustment for confounding co-morbidities including metabolic syndrome, diabetes and hypertension, the major causes of chronic kidney disease. Early dietary intervention to reduce weight, and where necessary bariatric surgery, should be considered in the management of overweight and obese chronic kidney disease (CKD) patients.

Kidney disease
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