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Quelles conseacutequences sur la fonction reacutenale
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
Obeacutesiteacute
ldquoLet me have men about me that are fat Sleek-headed men and
such as sleep orsquonights Yond Cassius has a lean and hungry look He thinks too much such men are dangerousrdquo
Source Julius Caesar Act 1 Scene 2 William Shakespeare (1564-1616)
ldquoIn recent years there has been an alarming rise in the prevalence of chronic kidney disease that has parralleled the increase in
the prevalence of obesityrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Hall et coll Am J Med Sci 2002
ldquoIncreasing evidence suggests that obesity is a potentially important contributor to
the development of CKDrdquo
Source Ting et coll Nephron Clin Pract 2009
Source httpbouzouwordpresscom
0
10
20
30
40
249292
54 81
1992
2007
BMI 25-30 BMI gt 30Source httpbagadminch
Evolution surpoids en Suisse
Obeacutesiteacute en Suisse
627
292
81
Population sans excegraves pondeacuteral Excegraves pondeacuteral (IMC gt 25) Adipositieacute (IMC gt 30)
Source httpbagadminch
ldquoit appears that the peak level in the adult overweight and obese segment
of the Swiss population may be reached in the near future ie the next
few years or ndash under best circumstances ndash may have been passed alreadyrdquo
Source httpbagadminch
ldquoBien que la preacutevalence des maladies reacutenales en relation avec lrsquoobeacutesiteacute ne soit pas clairement deacutefinie plusieurs eacutetudes reacutecentes ont montreacute
une correacutelation significative entre lrsquoIMC drsquoune part et la survenue drsquoune
proteacuteinurie ou drsquoune insuffisance reacutenale drsquoautre partrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Weisinger et coll Ann Intern Med 1974
ldquoFour patients with massive obesity and the nephrotic syndrome were studied In each case the proteinuria decreased during
dietary weight loss A mesangial glomerulopathy was present in two
patientsrdquo
ldquoIn the following years several case reports describing glomerulosclerosis in very
obese patients have been published but this entity was considered as rare and rather
bizarrerdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Metcalf et coll Clin Chem 1992
ldquoThe degree of albuminuria
showed piecewise log-linear relationship with body mass
index (P = 00001)rdquo
50
10
5
15
15
20 25 30 35 40 45 50
AlbuminmgL
Body mass index (kgm2)
5670 people older than 40 years
Source Iseki et coll Kidney Int 2004
0
375
75
1125
150
lt 210210-231
232-254255-
Total Men Women
N o
f ESR
D
BMI kgm2
Japon
Source Iseki et coll Kidney Int 2004
ldquoWe found that BMI was associated with an increased risk of the development of
end stage of renal disease in men in the general population in Okinawardquo
100rsquo753 screenees during follow-up 404 screenees developed ESRD
Japon
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoOverweight (BMI gt 25) at age 20 was associated with a significant three-fold excess risk for chronic renal failurerdquo
926 case patients and 998 control subjects
Suegravede
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoAfter mean follow-up of 185 years 244 participants (94) developed kidney disease Body mass index with odds ratio
123 (95 CI 108-141)rdquo
2rsquo585 participants with baseline and follow-up examination
Framingham Heart Study
Source Iseki et coll Kidney Int 2004
ldquoAfter an average 14-year follow-up 1rsquo377 participants (124) had a GFR less than 60 mL
min173 m2 Higher baseline BMI was associated consistently with increased
risk for CKD (OR 145)rdquo
11rsquo104 initially healthy men provided a blood sample after 14 years
PhysicianrsquoHealth Study
Source Stengel et coll Epidemiology 2003
ldquoThe study found that those with morbid obesity had more than double the risk of CKD (OR 23) compared to normal weight
individuals independent of age sex race smoking and physical activityrdquo
9rsquo082 adults with an average follow-up of 132 years
National Health and Nutrition Examination Survey (NHANES II)
Source Kramer et coll Am J Kidney Dis 2005
ldquoIn HDFP participants without CKD at baseline the incidence of CKD at year 5 was 28 in the ideal-body-mass-index group 31 in the overweight group (OR 121) and 34 in
the obese group (OR 140)rdquo
5rsquo897 hypertensive adults
Hypertension Detection and Follow-up Program (HDFP)
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ldquoORG was defined morphologically as focal segmental glomerulosclerosis and glomerulomegaly or glomerulomegaly
alonerdquo
6rsquo818 native renal biopsies
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x100 PAS x250
glomeacuteruloscleacuterose segmentaire et focale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x250
discregravete scleacuterose meacutesangiale focale et leacutesions ldquodiabeacutetoiumldesrdquo
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ME x2rsquo500 ME x2rsquo500
eacutepaississement focal de la membrane basale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x300
glomeacuterulomeacutegalie
Source Kambham et coll Kidney Int 2001
Glomeacuterulopathie lieacutee agrave lrsquoobeacutesiteacute
HSF idiopathique
Proteacuteinurie drsquoordre neacutephrotique 48 66
Syndrome neacutephrotique 56 54
Oedegravemes 35 68
Albumine seacuterique gl 39 29
cholesteacuterol seacuterique mgdl 229 335
Scleacuterose focale 10 39
Glomeacuterulomeacutegalie 100 10
Fusion podocytaire 40 75
ORG is distinct from idiopathic FSGS
ldquoObesity has not only been suggested to cause renal disease but also to
accelerate its deteriorationrdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Bonnet et coll Am J Kidney Dis 2000
ldquoIn a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA)
nephropathy the presence of an elevated BMI at RBI was significantly associated with the
severity of pathological renal lesionsrdquo
Maladie de Berger
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
ldquoLet me have men about me that are fat Sleek-headed men and
such as sleep orsquonights Yond Cassius has a lean and hungry look He thinks too much such men are dangerousrdquo
Source Julius Caesar Act 1 Scene 2 William Shakespeare (1564-1616)
ldquoIn recent years there has been an alarming rise in the prevalence of chronic kidney disease that has parralleled the increase in
the prevalence of obesityrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Hall et coll Am J Med Sci 2002
ldquoIncreasing evidence suggests that obesity is a potentially important contributor to
the development of CKDrdquo
Source Ting et coll Nephron Clin Pract 2009
Source httpbouzouwordpresscom
0
10
20
30
40
249292
54 81
1992
2007
BMI 25-30 BMI gt 30Source httpbagadminch
Evolution surpoids en Suisse
Obeacutesiteacute en Suisse
627
292
81
Population sans excegraves pondeacuteral Excegraves pondeacuteral (IMC gt 25) Adipositieacute (IMC gt 30)
Source httpbagadminch
ldquoit appears that the peak level in the adult overweight and obese segment
of the Swiss population may be reached in the near future ie the next
few years or ndash under best circumstances ndash may have been passed alreadyrdquo
Source httpbagadminch
ldquoBien que la preacutevalence des maladies reacutenales en relation avec lrsquoobeacutesiteacute ne soit pas clairement deacutefinie plusieurs eacutetudes reacutecentes ont montreacute
une correacutelation significative entre lrsquoIMC drsquoune part et la survenue drsquoune
proteacuteinurie ou drsquoune insuffisance reacutenale drsquoautre partrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Weisinger et coll Ann Intern Med 1974
ldquoFour patients with massive obesity and the nephrotic syndrome were studied In each case the proteinuria decreased during
dietary weight loss A mesangial glomerulopathy was present in two
patientsrdquo
ldquoIn the following years several case reports describing glomerulosclerosis in very
obese patients have been published but this entity was considered as rare and rather
bizarrerdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Metcalf et coll Clin Chem 1992
ldquoThe degree of albuminuria
showed piecewise log-linear relationship with body mass
index (P = 00001)rdquo
50
10
5
15
15
20 25 30 35 40 45 50
AlbuminmgL
Body mass index (kgm2)
5670 people older than 40 years
Source Iseki et coll Kidney Int 2004
0
375
75
1125
150
lt 210210-231
232-254255-
Total Men Women
N o
f ESR
D
BMI kgm2
Japon
Source Iseki et coll Kidney Int 2004
ldquoWe found that BMI was associated with an increased risk of the development of
end stage of renal disease in men in the general population in Okinawardquo
100rsquo753 screenees during follow-up 404 screenees developed ESRD
Japon
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoOverweight (BMI gt 25) at age 20 was associated with a significant three-fold excess risk for chronic renal failurerdquo
926 case patients and 998 control subjects
Suegravede
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoAfter mean follow-up of 185 years 244 participants (94) developed kidney disease Body mass index with odds ratio
123 (95 CI 108-141)rdquo
2rsquo585 participants with baseline and follow-up examination
Framingham Heart Study
Source Iseki et coll Kidney Int 2004
ldquoAfter an average 14-year follow-up 1rsquo377 participants (124) had a GFR less than 60 mL
min173 m2 Higher baseline BMI was associated consistently with increased
risk for CKD (OR 145)rdquo
11rsquo104 initially healthy men provided a blood sample after 14 years
PhysicianrsquoHealth Study
Source Stengel et coll Epidemiology 2003
ldquoThe study found that those with morbid obesity had more than double the risk of CKD (OR 23) compared to normal weight
individuals independent of age sex race smoking and physical activityrdquo
9rsquo082 adults with an average follow-up of 132 years
National Health and Nutrition Examination Survey (NHANES II)
Source Kramer et coll Am J Kidney Dis 2005
ldquoIn HDFP participants without CKD at baseline the incidence of CKD at year 5 was 28 in the ideal-body-mass-index group 31 in the overweight group (OR 121) and 34 in
the obese group (OR 140)rdquo
5rsquo897 hypertensive adults
Hypertension Detection and Follow-up Program (HDFP)
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ldquoORG was defined morphologically as focal segmental glomerulosclerosis and glomerulomegaly or glomerulomegaly
alonerdquo
6rsquo818 native renal biopsies
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x100 PAS x250
glomeacuteruloscleacuterose segmentaire et focale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x250
discregravete scleacuterose meacutesangiale focale et leacutesions ldquodiabeacutetoiumldesrdquo
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ME x2rsquo500 ME x2rsquo500
eacutepaississement focal de la membrane basale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x300
glomeacuterulomeacutegalie
Source Kambham et coll Kidney Int 2001
Glomeacuterulopathie lieacutee agrave lrsquoobeacutesiteacute
HSF idiopathique
Proteacuteinurie drsquoordre neacutephrotique 48 66
Syndrome neacutephrotique 56 54
Oedegravemes 35 68
Albumine seacuterique gl 39 29
cholesteacuterol seacuterique mgdl 229 335
Scleacuterose focale 10 39
Glomeacuterulomeacutegalie 100 10
Fusion podocytaire 40 75
ORG is distinct from idiopathic FSGS
ldquoObesity has not only been suggested to cause renal disease but also to
accelerate its deteriorationrdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Bonnet et coll Am J Kidney Dis 2000
ldquoIn a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA)
nephropathy the presence of an elevated BMI at RBI was significantly associated with the
severity of pathological renal lesionsrdquo
Maladie de Berger
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
ldquoIn recent years there has been an alarming rise in the prevalence of chronic kidney disease that has parralleled the increase in
the prevalence of obesityrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Hall et coll Am J Med Sci 2002
ldquoIncreasing evidence suggests that obesity is a potentially important contributor to
the development of CKDrdquo
Source Ting et coll Nephron Clin Pract 2009
Source httpbouzouwordpresscom
0
10
20
30
40
249292
54 81
1992
2007
BMI 25-30 BMI gt 30Source httpbagadminch
Evolution surpoids en Suisse
Obeacutesiteacute en Suisse
627
292
81
Population sans excegraves pondeacuteral Excegraves pondeacuteral (IMC gt 25) Adipositieacute (IMC gt 30)
Source httpbagadminch
ldquoit appears that the peak level in the adult overweight and obese segment
of the Swiss population may be reached in the near future ie the next
few years or ndash under best circumstances ndash may have been passed alreadyrdquo
Source httpbagadminch
ldquoBien que la preacutevalence des maladies reacutenales en relation avec lrsquoobeacutesiteacute ne soit pas clairement deacutefinie plusieurs eacutetudes reacutecentes ont montreacute
une correacutelation significative entre lrsquoIMC drsquoune part et la survenue drsquoune
proteacuteinurie ou drsquoune insuffisance reacutenale drsquoautre partrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Weisinger et coll Ann Intern Med 1974
ldquoFour patients with massive obesity and the nephrotic syndrome were studied In each case the proteinuria decreased during
dietary weight loss A mesangial glomerulopathy was present in two
patientsrdquo
ldquoIn the following years several case reports describing glomerulosclerosis in very
obese patients have been published but this entity was considered as rare and rather
bizarrerdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Metcalf et coll Clin Chem 1992
ldquoThe degree of albuminuria
showed piecewise log-linear relationship with body mass
index (P = 00001)rdquo
50
10
5
15
15
20 25 30 35 40 45 50
AlbuminmgL
Body mass index (kgm2)
5670 people older than 40 years
Source Iseki et coll Kidney Int 2004
0
375
75
1125
150
lt 210210-231
232-254255-
Total Men Women
N o
f ESR
D
BMI kgm2
Japon
Source Iseki et coll Kidney Int 2004
ldquoWe found that BMI was associated with an increased risk of the development of
end stage of renal disease in men in the general population in Okinawardquo
100rsquo753 screenees during follow-up 404 screenees developed ESRD
Japon
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoOverweight (BMI gt 25) at age 20 was associated with a significant three-fold excess risk for chronic renal failurerdquo
926 case patients and 998 control subjects
Suegravede
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoAfter mean follow-up of 185 years 244 participants (94) developed kidney disease Body mass index with odds ratio
123 (95 CI 108-141)rdquo
2rsquo585 participants with baseline and follow-up examination
Framingham Heart Study
Source Iseki et coll Kidney Int 2004
ldquoAfter an average 14-year follow-up 1rsquo377 participants (124) had a GFR less than 60 mL
min173 m2 Higher baseline BMI was associated consistently with increased
risk for CKD (OR 145)rdquo
11rsquo104 initially healthy men provided a blood sample after 14 years
PhysicianrsquoHealth Study
Source Stengel et coll Epidemiology 2003
ldquoThe study found that those with morbid obesity had more than double the risk of CKD (OR 23) compared to normal weight
individuals independent of age sex race smoking and physical activityrdquo
9rsquo082 adults with an average follow-up of 132 years
National Health and Nutrition Examination Survey (NHANES II)
Source Kramer et coll Am J Kidney Dis 2005
ldquoIn HDFP participants without CKD at baseline the incidence of CKD at year 5 was 28 in the ideal-body-mass-index group 31 in the overweight group (OR 121) and 34 in
the obese group (OR 140)rdquo
5rsquo897 hypertensive adults
Hypertension Detection and Follow-up Program (HDFP)
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ldquoORG was defined morphologically as focal segmental glomerulosclerosis and glomerulomegaly or glomerulomegaly
alonerdquo
6rsquo818 native renal biopsies
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x100 PAS x250
glomeacuteruloscleacuterose segmentaire et focale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x250
discregravete scleacuterose meacutesangiale focale et leacutesions ldquodiabeacutetoiumldesrdquo
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ME x2rsquo500 ME x2rsquo500
eacutepaississement focal de la membrane basale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x300
glomeacuterulomeacutegalie
Source Kambham et coll Kidney Int 2001
Glomeacuterulopathie lieacutee agrave lrsquoobeacutesiteacute
HSF idiopathique
Proteacuteinurie drsquoordre neacutephrotique 48 66
Syndrome neacutephrotique 56 54
Oedegravemes 35 68
Albumine seacuterique gl 39 29
cholesteacuterol seacuterique mgdl 229 335
Scleacuterose focale 10 39
Glomeacuterulomeacutegalie 100 10
Fusion podocytaire 40 75
ORG is distinct from idiopathic FSGS
ldquoObesity has not only been suggested to cause renal disease but also to
accelerate its deteriorationrdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Bonnet et coll Am J Kidney Dis 2000
ldquoIn a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA)
nephropathy the presence of an elevated BMI at RBI was significantly associated with the
severity of pathological renal lesionsrdquo
Maladie de Berger
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Hall et coll Am J Med Sci 2002
ldquoIncreasing evidence suggests that obesity is a potentially important contributor to
the development of CKDrdquo
Source Ting et coll Nephron Clin Pract 2009
Source httpbouzouwordpresscom
0
10
20
30
40
249292
54 81
1992
2007
BMI 25-30 BMI gt 30Source httpbagadminch
Evolution surpoids en Suisse
Obeacutesiteacute en Suisse
627
292
81
Population sans excegraves pondeacuteral Excegraves pondeacuteral (IMC gt 25) Adipositieacute (IMC gt 30)
Source httpbagadminch
ldquoit appears that the peak level in the adult overweight and obese segment
of the Swiss population may be reached in the near future ie the next
few years or ndash under best circumstances ndash may have been passed alreadyrdquo
Source httpbagadminch
ldquoBien que la preacutevalence des maladies reacutenales en relation avec lrsquoobeacutesiteacute ne soit pas clairement deacutefinie plusieurs eacutetudes reacutecentes ont montreacute
une correacutelation significative entre lrsquoIMC drsquoune part et la survenue drsquoune
proteacuteinurie ou drsquoune insuffisance reacutenale drsquoautre partrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Weisinger et coll Ann Intern Med 1974
ldquoFour patients with massive obesity and the nephrotic syndrome were studied In each case the proteinuria decreased during
dietary weight loss A mesangial glomerulopathy was present in two
patientsrdquo
ldquoIn the following years several case reports describing glomerulosclerosis in very
obese patients have been published but this entity was considered as rare and rather
bizarrerdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Metcalf et coll Clin Chem 1992
ldquoThe degree of albuminuria
showed piecewise log-linear relationship with body mass
index (P = 00001)rdquo
50
10
5
15
15
20 25 30 35 40 45 50
AlbuminmgL
Body mass index (kgm2)
5670 people older than 40 years
Source Iseki et coll Kidney Int 2004
0
375
75
1125
150
lt 210210-231
232-254255-
Total Men Women
N o
f ESR
D
BMI kgm2
Japon
Source Iseki et coll Kidney Int 2004
ldquoWe found that BMI was associated with an increased risk of the development of
end stage of renal disease in men in the general population in Okinawardquo
100rsquo753 screenees during follow-up 404 screenees developed ESRD
Japon
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoOverweight (BMI gt 25) at age 20 was associated with a significant three-fold excess risk for chronic renal failurerdquo
926 case patients and 998 control subjects
Suegravede
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoAfter mean follow-up of 185 years 244 participants (94) developed kidney disease Body mass index with odds ratio
123 (95 CI 108-141)rdquo
2rsquo585 participants with baseline and follow-up examination
Framingham Heart Study
Source Iseki et coll Kidney Int 2004
ldquoAfter an average 14-year follow-up 1rsquo377 participants (124) had a GFR less than 60 mL
min173 m2 Higher baseline BMI was associated consistently with increased
risk for CKD (OR 145)rdquo
11rsquo104 initially healthy men provided a blood sample after 14 years
PhysicianrsquoHealth Study
Source Stengel et coll Epidemiology 2003
ldquoThe study found that those with morbid obesity had more than double the risk of CKD (OR 23) compared to normal weight
individuals independent of age sex race smoking and physical activityrdquo
9rsquo082 adults with an average follow-up of 132 years
National Health and Nutrition Examination Survey (NHANES II)
Source Kramer et coll Am J Kidney Dis 2005
ldquoIn HDFP participants without CKD at baseline the incidence of CKD at year 5 was 28 in the ideal-body-mass-index group 31 in the overweight group (OR 121) and 34 in
the obese group (OR 140)rdquo
5rsquo897 hypertensive adults
Hypertension Detection and Follow-up Program (HDFP)
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ldquoORG was defined morphologically as focal segmental glomerulosclerosis and glomerulomegaly or glomerulomegaly
alonerdquo
6rsquo818 native renal biopsies
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x100 PAS x250
glomeacuteruloscleacuterose segmentaire et focale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x250
discregravete scleacuterose meacutesangiale focale et leacutesions ldquodiabeacutetoiumldesrdquo
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ME x2rsquo500 ME x2rsquo500
eacutepaississement focal de la membrane basale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x300
glomeacuterulomeacutegalie
Source Kambham et coll Kidney Int 2001
Glomeacuterulopathie lieacutee agrave lrsquoobeacutesiteacute
HSF idiopathique
Proteacuteinurie drsquoordre neacutephrotique 48 66
Syndrome neacutephrotique 56 54
Oedegravemes 35 68
Albumine seacuterique gl 39 29
cholesteacuterol seacuterique mgdl 229 335
Scleacuterose focale 10 39
Glomeacuterulomeacutegalie 100 10
Fusion podocytaire 40 75
ORG is distinct from idiopathic FSGS
ldquoObesity has not only been suggested to cause renal disease but also to
accelerate its deteriorationrdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Bonnet et coll Am J Kidney Dis 2000
ldquoIn a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA)
nephropathy the presence of an elevated BMI at RBI was significantly associated with the
severity of pathological renal lesionsrdquo
Maladie de Berger
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
ldquoIncreasing evidence suggests that obesity is a potentially important contributor to
the development of CKDrdquo
Source Ting et coll Nephron Clin Pract 2009
Source httpbouzouwordpresscom
0
10
20
30
40
249292
54 81
1992
2007
BMI 25-30 BMI gt 30Source httpbagadminch
Evolution surpoids en Suisse
Obeacutesiteacute en Suisse
627
292
81
Population sans excegraves pondeacuteral Excegraves pondeacuteral (IMC gt 25) Adipositieacute (IMC gt 30)
Source httpbagadminch
ldquoit appears that the peak level in the adult overweight and obese segment
of the Swiss population may be reached in the near future ie the next
few years or ndash under best circumstances ndash may have been passed alreadyrdquo
Source httpbagadminch
ldquoBien que la preacutevalence des maladies reacutenales en relation avec lrsquoobeacutesiteacute ne soit pas clairement deacutefinie plusieurs eacutetudes reacutecentes ont montreacute
une correacutelation significative entre lrsquoIMC drsquoune part et la survenue drsquoune
proteacuteinurie ou drsquoune insuffisance reacutenale drsquoautre partrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Weisinger et coll Ann Intern Med 1974
ldquoFour patients with massive obesity and the nephrotic syndrome were studied In each case the proteinuria decreased during
dietary weight loss A mesangial glomerulopathy was present in two
patientsrdquo
ldquoIn the following years several case reports describing glomerulosclerosis in very
obese patients have been published but this entity was considered as rare and rather
bizarrerdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Metcalf et coll Clin Chem 1992
ldquoThe degree of albuminuria
showed piecewise log-linear relationship with body mass
index (P = 00001)rdquo
50
10
5
15
15
20 25 30 35 40 45 50
AlbuminmgL
Body mass index (kgm2)
5670 people older than 40 years
Source Iseki et coll Kidney Int 2004
0
375
75
1125
150
lt 210210-231
232-254255-
Total Men Women
N o
f ESR
D
BMI kgm2
Japon
Source Iseki et coll Kidney Int 2004
ldquoWe found that BMI was associated with an increased risk of the development of
end stage of renal disease in men in the general population in Okinawardquo
100rsquo753 screenees during follow-up 404 screenees developed ESRD
Japon
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoOverweight (BMI gt 25) at age 20 was associated with a significant three-fold excess risk for chronic renal failurerdquo
926 case patients and 998 control subjects
Suegravede
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoAfter mean follow-up of 185 years 244 participants (94) developed kidney disease Body mass index with odds ratio
123 (95 CI 108-141)rdquo
2rsquo585 participants with baseline and follow-up examination
Framingham Heart Study
Source Iseki et coll Kidney Int 2004
ldquoAfter an average 14-year follow-up 1rsquo377 participants (124) had a GFR less than 60 mL
min173 m2 Higher baseline BMI was associated consistently with increased
risk for CKD (OR 145)rdquo
11rsquo104 initially healthy men provided a blood sample after 14 years
PhysicianrsquoHealth Study
Source Stengel et coll Epidemiology 2003
ldquoThe study found that those with morbid obesity had more than double the risk of CKD (OR 23) compared to normal weight
individuals independent of age sex race smoking and physical activityrdquo
9rsquo082 adults with an average follow-up of 132 years
National Health and Nutrition Examination Survey (NHANES II)
Source Kramer et coll Am J Kidney Dis 2005
ldquoIn HDFP participants without CKD at baseline the incidence of CKD at year 5 was 28 in the ideal-body-mass-index group 31 in the overweight group (OR 121) and 34 in
the obese group (OR 140)rdquo
5rsquo897 hypertensive adults
Hypertension Detection and Follow-up Program (HDFP)
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ldquoORG was defined morphologically as focal segmental glomerulosclerosis and glomerulomegaly or glomerulomegaly
alonerdquo
6rsquo818 native renal biopsies
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x100 PAS x250
glomeacuteruloscleacuterose segmentaire et focale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x250
discregravete scleacuterose meacutesangiale focale et leacutesions ldquodiabeacutetoiumldesrdquo
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ME x2rsquo500 ME x2rsquo500
eacutepaississement focal de la membrane basale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x300
glomeacuterulomeacutegalie
Source Kambham et coll Kidney Int 2001
Glomeacuterulopathie lieacutee agrave lrsquoobeacutesiteacute
HSF idiopathique
Proteacuteinurie drsquoordre neacutephrotique 48 66
Syndrome neacutephrotique 56 54
Oedegravemes 35 68
Albumine seacuterique gl 39 29
cholesteacuterol seacuterique mgdl 229 335
Scleacuterose focale 10 39
Glomeacuterulomeacutegalie 100 10
Fusion podocytaire 40 75
ORG is distinct from idiopathic FSGS
ldquoObesity has not only been suggested to cause renal disease but also to
accelerate its deteriorationrdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Bonnet et coll Am J Kidney Dis 2000
ldquoIn a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA)
nephropathy the presence of an elevated BMI at RBI was significantly associated with the
severity of pathological renal lesionsrdquo
Maladie de Berger
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source httpbouzouwordpresscom
0
10
20
30
40
249292
54 81
1992
2007
BMI 25-30 BMI gt 30Source httpbagadminch
Evolution surpoids en Suisse
Obeacutesiteacute en Suisse
627
292
81
Population sans excegraves pondeacuteral Excegraves pondeacuteral (IMC gt 25) Adipositieacute (IMC gt 30)
Source httpbagadminch
ldquoit appears that the peak level in the adult overweight and obese segment
of the Swiss population may be reached in the near future ie the next
few years or ndash under best circumstances ndash may have been passed alreadyrdquo
Source httpbagadminch
ldquoBien que la preacutevalence des maladies reacutenales en relation avec lrsquoobeacutesiteacute ne soit pas clairement deacutefinie plusieurs eacutetudes reacutecentes ont montreacute
une correacutelation significative entre lrsquoIMC drsquoune part et la survenue drsquoune
proteacuteinurie ou drsquoune insuffisance reacutenale drsquoautre partrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Weisinger et coll Ann Intern Med 1974
ldquoFour patients with massive obesity and the nephrotic syndrome were studied In each case the proteinuria decreased during
dietary weight loss A mesangial glomerulopathy was present in two
patientsrdquo
ldquoIn the following years several case reports describing glomerulosclerosis in very
obese patients have been published but this entity was considered as rare and rather
bizarrerdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Metcalf et coll Clin Chem 1992
ldquoThe degree of albuminuria
showed piecewise log-linear relationship with body mass
index (P = 00001)rdquo
50
10
5
15
15
20 25 30 35 40 45 50
AlbuminmgL
Body mass index (kgm2)
5670 people older than 40 years
Source Iseki et coll Kidney Int 2004
0
375
75
1125
150
lt 210210-231
232-254255-
Total Men Women
N o
f ESR
D
BMI kgm2
Japon
Source Iseki et coll Kidney Int 2004
ldquoWe found that BMI was associated with an increased risk of the development of
end stage of renal disease in men in the general population in Okinawardquo
100rsquo753 screenees during follow-up 404 screenees developed ESRD
Japon
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoOverweight (BMI gt 25) at age 20 was associated with a significant three-fold excess risk for chronic renal failurerdquo
926 case patients and 998 control subjects
Suegravede
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoAfter mean follow-up of 185 years 244 participants (94) developed kidney disease Body mass index with odds ratio
123 (95 CI 108-141)rdquo
2rsquo585 participants with baseline and follow-up examination
Framingham Heart Study
Source Iseki et coll Kidney Int 2004
ldquoAfter an average 14-year follow-up 1rsquo377 participants (124) had a GFR less than 60 mL
min173 m2 Higher baseline BMI was associated consistently with increased
risk for CKD (OR 145)rdquo
11rsquo104 initially healthy men provided a blood sample after 14 years
PhysicianrsquoHealth Study
Source Stengel et coll Epidemiology 2003
ldquoThe study found that those with morbid obesity had more than double the risk of CKD (OR 23) compared to normal weight
individuals independent of age sex race smoking and physical activityrdquo
9rsquo082 adults with an average follow-up of 132 years
National Health and Nutrition Examination Survey (NHANES II)
Source Kramer et coll Am J Kidney Dis 2005
ldquoIn HDFP participants without CKD at baseline the incidence of CKD at year 5 was 28 in the ideal-body-mass-index group 31 in the overweight group (OR 121) and 34 in
the obese group (OR 140)rdquo
5rsquo897 hypertensive adults
Hypertension Detection and Follow-up Program (HDFP)
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ldquoORG was defined morphologically as focal segmental glomerulosclerosis and glomerulomegaly or glomerulomegaly
alonerdquo
6rsquo818 native renal biopsies
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x100 PAS x250
glomeacuteruloscleacuterose segmentaire et focale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x250
discregravete scleacuterose meacutesangiale focale et leacutesions ldquodiabeacutetoiumldesrdquo
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ME x2rsquo500 ME x2rsquo500
eacutepaississement focal de la membrane basale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x300
glomeacuterulomeacutegalie
Source Kambham et coll Kidney Int 2001
Glomeacuterulopathie lieacutee agrave lrsquoobeacutesiteacute
HSF idiopathique
Proteacuteinurie drsquoordre neacutephrotique 48 66
Syndrome neacutephrotique 56 54
Oedegravemes 35 68
Albumine seacuterique gl 39 29
cholesteacuterol seacuterique mgdl 229 335
Scleacuterose focale 10 39
Glomeacuterulomeacutegalie 100 10
Fusion podocytaire 40 75
ORG is distinct from idiopathic FSGS
ldquoObesity has not only been suggested to cause renal disease but also to
accelerate its deteriorationrdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Bonnet et coll Am J Kidney Dis 2000
ldquoIn a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA)
nephropathy the presence of an elevated BMI at RBI was significantly associated with the
severity of pathological renal lesionsrdquo
Maladie de Berger
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
0
10
20
30
40
249292
54 81
1992
2007
BMI 25-30 BMI gt 30Source httpbagadminch
Evolution surpoids en Suisse
Obeacutesiteacute en Suisse
627
292
81
Population sans excegraves pondeacuteral Excegraves pondeacuteral (IMC gt 25) Adipositieacute (IMC gt 30)
Source httpbagadminch
ldquoit appears that the peak level in the adult overweight and obese segment
of the Swiss population may be reached in the near future ie the next
few years or ndash under best circumstances ndash may have been passed alreadyrdquo
Source httpbagadminch
ldquoBien que la preacutevalence des maladies reacutenales en relation avec lrsquoobeacutesiteacute ne soit pas clairement deacutefinie plusieurs eacutetudes reacutecentes ont montreacute
une correacutelation significative entre lrsquoIMC drsquoune part et la survenue drsquoune
proteacuteinurie ou drsquoune insuffisance reacutenale drsquoautre partrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Weisinger et coll Ann Intern Med 1974
ldquoFour patients with massive obesity and the nephrotic syndrome were studied In each case the proteinuria decreased during
dietary weight loss A mesangial glomerulopathy was present in two
patientsrdquo
ldquoIn the following years several case reports describing glomerulosclerosis in very
obese patients have been published but this entity was considered as rare and rather
bizarrerdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Metcalf et coll Clin Chem 1992
ldquoThe degree of albuminuria
showed piecewise log-linear relationship with body mass
index (P = 00001)rdquo
50
10
5
15
15
20 25 30 35 40 45 50
AlbuminmgL
Body mass index (kgm2)
5670 people older than 40 years
Source Iseki et coll Kidney Int 2004
0
375
75
1125
150
lt 210210-231
232-254255-
Total Men Women
N o
f ESR
D
BMI kgm2
Japon
Source Iseki et coll Kidney Int 2004
ldquoWe found that BMI was associated with an increased risk of the development of
end stage of renal disease in men in the general population in Okinawardquo
100rsquo753 screenees during follow-up 404 screenees developed ESRD
Japon
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoOverweight (BMI gt 25) at age 20 was associated with a significant three-fold excess risk for chronic renal failurerdquo
926 case patients and 998 control subjects
Suegravede
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoAfter mean follow-up of 185 years 244 participants (94) developed kidney disease Body mass index with odds ratio
123 (95 CI 108-141)rdquo
2rsquo585 participants with baseline and follow-up examination
Framingham Heart Study
Source Iseki et coll Kidney Int 2004
ldquoAfter an average 14-year follow-up 1rsquo377 participants (124) had a GFR less than 60 mL
min173 m2 Higher baseline BMI was associated consistently with increased
risk for CKD (OR 145)rdquo
11rsquo104 initially healthy men provided a blood sample after 14 years
PhysicianrsquoHealth Study
Source Stengel et coll Epidemiology 2003
ldquoThe study found that those with morbid obesity had more than double the risk of CKD (OR 23) compared to normal weight
individuals independent of age sex race smoking and physical activityrdquo
9rsquo082 adults with an average follow-up of 132 years
National Health and Nutrition Examination Survey (NHANES II)
Source Kramer et coll Am J Kidney Dis 2005
ldquoIn HDFP participants without CKD at baseline the incidence of CKD at year 5 was 28 in the ideal-body-mass-index group 31 in the overweight group (OR 121) and 34 in
the obese group (OR 140)rdquo
5rsquo897 hypertensive adults
Hypertension Detection and Follow-up Program (HDFP)
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ldquoORG was defined morphologically as focal segmental glomerulosclerosis and glomerulomegaly or glomerulomegaly
alonerdquo
6rsquo818 native renal biopsies
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x100 PAS x250
glomeacuteruloscleacuterose segmentaire et focale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x250
discregravete scleacuterose meacutesangiale focale et leacutesions ldquodiabeacutetoiumldesrdquo
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ME x2rsquo500 ME x2rsquo500
eacutepaississement focal de la membrane basale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x300
glomeacuterulomeacutegalie
Source Kambham et coll Kidney Int 2001
Glomeacuterulopathie lieacutee agrave lrsquoobeacutesiteacute
HSF idiopathique
Proteacuteinurie drsquoordre neacutephrotique 48 66
Syndrome neacutephrotique 56 54
Oedegravemes 35 68
Albumine seacuterique gl 39 29
cholesteacuterol seacuterique mgdl 229 335
Scleacuterose focale 10 39
Glomeacuterulomeacutegalie 100 10
Fusion podocytaire 40 75
ORG is distinct from idiopathic FSGS
ldquoObesity has not only been suggested to cause renal disease but also to
accelerate its deteriorationrdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Bonnet et coll Am J Kidney Dis 2000
ldquoIn a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA)
nephropathy the presence of an elevated BMI at RBI was significantly associated with the
severity of pathological renal lesionsrdquo
Maladie de Berger
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Obeacutesiteacute en Suisse
627
292
81
Population sans excegraves pondeacuteral Excegraves pondeacuteral (IMC gt 25) Adipositieacute (IMC gt 30)
Source httpbagadminch
ldquoit appears that the peak level in the adult overweight and obese segment
of the Swiss population may be reached in the near future ie the next
few years or ndash under best circumstances ndash may have been passed alreadyrdquo
Source httpbagadminch
ldquoBien que la preacutevalence des maladies reacutenales en relation avec lrsquoobeacutesiteacute ne soit pas clairement deacutefinie plusieurs eacutetudes reacutecentes ont montreacute
une correacutelation significative entre lrsquoIMC drsquoune part et la survenue drsquoune
proteacuteinurie ou drsquoune insuffisance reacutenale drsquoautre partrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Weisinger et coll Ann Intern Med 1974
ldquoFour patients with massive obesity and the nephrotic syndrome were studied In each case the proteinuria decreased during
dietary weight loss A mesangial glomerulopathy was present in two
patientsrdquo
ldquoIn the following years several case reports describing glomerulosclerosis in very
obese patients have been published but this entity was considered as rare and rather
bizarrerdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Metcalf et coll Clin Chem 1992
ldquoThe degree of albuminuria
showed piecewise log-linear relationship with body mass
index (P = 00001)rdquo
50
10
5
15
15
20 25 30 35 40 45 50
AlbuminmgL
Body mass index (kgm2)
5670 people older than 40 years
Source Iseki et coll Kidney Int 2004
0
375
75
1125
150
lt 210210-231
232-254255-
Total Men Women
N o
f ESR
D
BMI kgm2
Japon
Source Iseki et coll Kidney Int 2004
ldquoWe found that BMI was associated with an increased risk of the development of
end stage of renal disease in men in the general population in Okinawardquo
100rsquo753 screenees during follow-up 404 screenees developed ESRD
Japon
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoOverweight (BMI gt 25) at age 20 was associated with a significant three-fold excess risk for chronic renal failurerdquo
926 case patients and 998 control subjects
Suegravede
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoAfter mean follow-up of 185 years 244 participants (94) developed kidney disease Body mass index with odds ratio
123 (95 CI 108-141)rdquo
2rsquo585 participants with baseline and follow-up examination
Framingham Heart Study
Source Iseki et coll Kidney Int 2004
ldquoAfter an average 14-year follow-up 1rsquo377 participants (124) had a GFR less than 60 mL
min173 m2 Higher baseline BMI was associated consistently with increased
risk for CKD (OR 145)rdquo
11rsquo104 initially healthy men provided a blood sample after 14 years
PhysicianrsquoHealth Study
Source Stengel et coll Epidemiology 2003
ldquoThe study found that those with morbid obesity had more than double the risk of CKD (OR 23) compared to normal weight
individuals independent of age sex race smoking and physical activityrdquo
9rsquo082 adults with an average follow-up of 132 years
National Health and Nutrition Examination Survey (NHANES II)
Source Kramer et coll Am J Kidney Dis 2005
ldquoIn HDFP participants without CKD at baseline the incidence of CKD at year 5 was 28 in the ideal-body-mass-index group 31 in the overweight group (OR 121) and 34 in
the obese group (OR 140)rdquo
5rsquo897 hypertensive adults
Hypertension Detection and Follow-up Program (HDFP)
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ldquoORG was defined morphologically as focal segmental glomerulosclerosis and glomerulomegaly or glomerulomegaly
alonerdquo
6rsquo818 native renal biopsies
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x100 PAS x250
glomeacuteruloscleacuterose segmentaire et focale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x250
discregravete scleacuterose meacutesangiale focale et leacutesions ldquodiabeacutetoiumldesrdquo
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ME x2rsquo500 ME x2rsquo500
eacutepaississement focal de la membrane basale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x300
glomeacuterulomeacutegalie
Source Kambham et coll Kidney Int 2001
Glomeacuterulopathie lieacutee agrave lrsquoobeacutesiteacute
HSF idiopathique
Proteacuteinurie drsquoordre neacutephrotique 48 66
Syndrome neacutephrotique 56 54
Oedegravemes 35 68
Albumine seacuterique gl 39 29
cholesteacuterol seacuterique mgdl 229 335
Scleacuterose focale 10 39
Glomeacuterulomeacutegalie 100 10
Fusion podocytaire 40 75
ORG is distinct from idiopathic FSGS
ldquoObesity has not only been suggested to cause renal disease but also to
accelerate its deteriorationrdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Bonnet et coll Am J Kidney Dis 2000
ldquoIn a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA)
nephropathy the presence of an elevated BMI at RBI was significantly associated with the
severity of pathological renal lesionsrdquo
Maladie de Berger
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
ldquoit appears that the peak level in the adult overweight and obese segment
of the Swiss population may be reached in the near future ie the next
few years or ndash under best circumstances ndash may have been passed alreadyrdquo
Source httpbagadminch
ldquoBien que la preacutevalence des maladies reacutenales en relation avec lrsquoobeacutesiteacute ne soit pas clairement deacutefinie plusieurs eacutetudes reacutecentes ont montreacute
une correacutelation significative entre lrsquoIMC drsquoune part et la survenue drsquoune
proteacuteinurie ou drsquoune insuffisance reacutenale drsquoautre partrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Weisinger et coll Ann Intern Med 1974
ldquoFour patients with massive obesity and the nephrotic syndrome were studied In each case the proteinuria decreased during
dietary weight loss A mesangial glomerulopathy was present in two
patientsrdquo
ldquoIn the following years several case reports describing glomerulosclerosis in very
obese patients have been published but this entity was considered as rare and rather
bizarrerdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Metcalf et coll Clin Chem 1992
ldquoThe degree of albuminuria
showed piecewise log-linear relationship with body mass
index (P = 00001)rdquo
50
10
5
15
15
20 25 30 35 40 45 50
AlbuminmgL
Body mass index (kgm2)
5670 people older than 40 years
Source Iseki et coll Kidney Int 2004
0
375
75
1125
150
lt 210210-231
232-254255-
Total Men Women
N o
f ESR
D
BMI kgm2
Japon
Source Iseki et coll Kidney Int 2004
ldquoWe found that BMI was associated with an increased risk of the development of
end stage of renal disease in men in the general population in Okinawardquo
100rsquo753 screenees during follow-up 404 screenees developed ESRD
Japon
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoOverweight (BMI gt 25) at age 20 was associated with a significant three-fold excess risk for chronic renal failurerdquo
926 case patients and 998 control subjects
Suegravede
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoAfter mean follow-up of 185 years 244 participants (94) developed kidney disease Body mass index with odds ratio
123 (95 CI 108-141)rdquo
2rsquo585 participants with baseline and follow-up examination
Framingham Heart Study
Source Iseki et coll Kidney Int 2004
ldquoAfter an average 14-year follow-up 1rsquo377 participants (124) had a GFR less than 60 mL
min173 m2 Higher baseline BMI was associated consistently with increased
risk for CKD (OR 145)rdquo
11rsquo104 initially healthy men provided a blood sample after 14 years
PhysicianrsquoHealth Study
Source Stengel et coll Epidemiology 2003
ldquoThe study found that those with morbid obesity had more than double the risk of CKD (OR 23) compared to normal weight
individuals independent of age sex race smoking and physical activityrdquo
9rsquo082 adults with an average follow-up of 132 years
National Health and Nutrition Examination Survey (NHANES II)
Source Kramer et coll Am J Kidney Dis 2005
ldquoIn HDFP participants without CKD at baseline the incidence of CKD at year 5 was 28 in the ideal-body-mass-index group 31 in the overweight group (OR 121) and 34 in
the obese group (OR 140)rdquo
5rsquo897 hypertensive adults
Hypertension Detection and Follow-up Program (HDFP)
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ldquoORG was defined morphologically as focal segmental glomerulosclerosis and glomerulomegaly or glomerulomegaly
alonerdquo
6rsquo818 native renal biopsies
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x100 PAS x250
glomeacuteruloscleacuterose segmentaire et focale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x250
discregravete scleacuterose meacutesangiale focale et leacutesions ldquodiabeacutetoiumldesrdquo
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ME x2rsquo500 ME x2rsquo500
eacutepaississement focal de la membrane basale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x300
glomeacuterulomeacutegalie
Source Kambham et coll Kidney Int 2001
Glomeacuterulopathie lieacutee agrave lrsquoobeacutesiteacute
HSF idiopathique
Proteacuteinurie drsquoordre neacutephrotique 48 66
Syndrome neacutephrotique 56 54
Oedegravemes 35 68
Albumine seacuterique gl 39 29
cholesteacuterol seacuterique mgdl 229 335
Scleacuterose focale 10 39
Glomeacuterulomeacutegalie 100 10
Fusion podocytaire 40 75
ORG is distinct from idiopathic FSGS
ldquoObesity has not only been suggested to cause renal disease but also to
accelerate its deteriorationrdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Bonnet et coll Am J Kidney Dis 2000
ldquoIn a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA)
nephropathy the presence of an elevated BMI at RBI was significantly associated with the
severity of pathological renal lesionsrdquo
Maladie de Berger
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
ldquoBien que la preacutevalence des maladies reacutenales en relation avec lrsquoobeacutesiteacute ne soit pas clairement deacutefinie plusieurs eacutetudes reacutecentes ont montreacute
une correacutelation significative entre lrsquoIMC drsquoune part et la survenue drsquoune
proteacuteinurie ou drsquoune insuffisance reacutenale drsquoautre partrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Weisinger et coll Ann Intern Med 1974
ldquoFour patients with massive obesity and the nephrotic syndrome were studied In each case the proteinuria decreased during
dietary weight loss A mesangial glomerulopathy was present in two
patientsrdquo
ldquoIn the following years several case reports describing glomerulosclerosis in very
obese patients have been published but this entity was considered as rare and rather
bizarrerdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Metcalf et coll Clin Chem 1992
ldquoThe degree of albuminuria
showed piecewise log-linear relationship with body mass
index (P = 00001)rdquo
50
10
5
15
15
20 25 30 35 40 45 50
AlbuminmgL
Body mass index (kgm2)
5670 people older than 40 years
Source Iseki et coll Kidney Int 2004
0
375
75
1125
150
lt 210210-231
232-254255-
Total Men Women
N o
f ESR
D
BMI kgm2
Japon
Source Iseki et coll Kidney Int 2004
ldquoWe found that BMI was associated with an increased risk of the development of
end stage of renal disease in men in the general population in Okinawardquo
100rsquo753 screenees during follow-up 404 screenees developed ESRD
Japon
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoOverweight (BMI gt 25) at age 20 was associated with a significant three-fold excess risk for chronic renal failurerdquo
926 case patients and 998 control subjects
Suegravede
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoAfter mean follow-up of 185 years 244 participants (94) developed kidney disease Body mass index with odds ratio
123 (95 CI 108-141)rdquo
2rsquo585 participants with baseline and follow-up examination
Framingham Heart Study
Source Iseki et coll Kidney Int 2004
ldquoAfter an average 14-year follow-up 1rsquo377 participants (124) had a GFR less than 60 mL
min173 m2 Higher baseline BMI was associated consistently with increased
risk for CKD (OR 145)rdquo
11rsquo104 initially healthy men provided a blood sample after 14 years
PhysicianrsquoHealth Study
Source Stengel et coll Epidemiology 2003
ldquoThe study found that those with morbid obesity had more than double the risk of CKD (OR 23) compared to normal weight
individuals independent of age sex race smoking and physical activityrdquo
9rsquo082 adults with an average follow-up of 132 years
National Health and Nutrition Examination Survey (NHANES II)
Source Kramer et coll Am J Kidney Dis 2005
ldquoIn HDFP participants without CKD at baseline the incidence of CKD at year 5 was 28 in the ideal-body-mass-index group 31 in the overweight group (OR 121) and 34 in
the obese group (OR 140)rdquo
5rsquo897 hypertensive adults
Hypertension Detection and Follow-up Program (HDFP)
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ldquoORG was defined morphologically as focal segmental glomerulosclerosis and glomerulomegaly or glomerulomegaly
alonerdquo
6rsquo818 native renal biopsies
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x100 PAS x250
glomeacuteruloscleacuterose segmentaire et focale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x250
discregravete scleacuterose meacutesangiale focale et leacutesions ldquodiabeacutetoiumldesrdquo
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ME x2rsquo500 ME x2rsquo500
eacutepaississement focal de la membrane basale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x300
glomeacuterulomeacutegalie
Source Kambham et coll Kidney Int 2001
Glomeacuterulopathie lieacutee agrave lrsquoobeacutesiteacute
HSF idiopathique
Proteacuteinurie drsquoordre neacutephrotique 48 66
Syndrome neacutephrotique 56 54
Oedegravemes 35 68
Albumine seacuterique gl 39 29
cholesteacuterol seacuterique mgdl 229 335
Scleacuterose focale 10 39
Glomeacuterulomeacutegalie 100 10
Fusion podocytaire 40 75
ORG is distinct from idiopathic FSGS
ldquoObesity has not only been suggested to cause renal disease but also to
accelerate its deteriorationrdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Bonnet et coll Am J Kidney Dis 2000
ldquoIn a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA)
nephropathy the presence of an elevated BMI at RBI was significantly associated with the
severity of pathological renal lesionsrdquo
Maladie de Berger
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Weisinger et coll Ann Intern Med 1974
ldquoFour patients with massive obesity and the nephrotic syndrome were studied In each case the proteinuria decreased during
dietary weight loss A mesangial glomerulopathy was present in two
patientsrdquo
ldquoIn the following years several case reports describing glomerulosclerosis in very
obese patients have been published but this entity was considered as rare and rather
bizarrerdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Metcalf et coll Clin Chem 1992
ldquoThe degree of albuminuria
showed piecewise log-linear relationship with body mass
index (P = 00001)rdquo
50
10
5
15
15
20 25 30 35 40 45 50
AlbuminmgL
Body mass index (kgm2)
5670 people older than 40 years
Source Iseki et coll Kidney Int 2004
0
375
75
1125
150
lt 210210-231
232-254255-
Total Men Women
N o
f ESR
D
BMI kgm2
Japon
Source Iseki et coll Kidney Int 2004
ldquoWe found that BMI was associated with an increased risk of the development of
end stage of renal disease in men in the general population in Okinawardquo
100rsquo753 screenees during follow-up 404 screenees developed ESRD
Japon
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoOverweight (BMI gt 25) at age 20 was associated with a significant three-fold excess risk for chronic renal failurerdquo
926 case patients and 998 control subjects
Suegravede
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoAfter mean follow-up of 185 years 244 participants (94) developed kidney disease Body mass index with odds ratio
123 (95 CI 108-141)rdquo
2rsquo585 participants with baseline and follow-up examination
Framingham Heart Study
Source Iseki et coll Kidney Int 2004
ldquoAfter an average 14-year follow-up 1rsquo377 participants (124) had a GFR less than 60 mL
min173 m2 Higher baseline BMI was associated consistently with increased
risk for CKD (OR 145)rdquo
11rsquo104 initially healthy men provided a blood sample after 14 years
PhysicianrsquoHealth Study
Source Stengel et coll Epidemiology 2003
ldquoThe study found that those with morbid obesity had more than double the risk of CKD (OR 23) compared to normal weight
individuals independent of age sex race smoking and physical activityrdquo
9rsquo082 adults with an average follow-up of 132 years
National Health and Nutrition Examination Survey (NHANES II)
Source Kramer et coll Am J Kidney Dis 2005
ldquoIn HDFP participants without CKD at baseline the incidence of CKD at year 5 was 28 in the ideal-body-mass-index group 31 in the overweight group (OR 121) and 34 in
the obese group (OR 140)rdquo
5rsquo897 hypertensive adults
Hypertension Detection and Follow-up Program (HDFP)
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ldquoORG was defined morphologically as focal segmental glomerulosclerosis and glomerulomegaly or glomerulomegaly
alonerdquo
6rsquo818 native renal biopsies
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x100 PAS x250
glomeacuteruloscleacuterose segmentaire et focale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x250
discregravete scleacuterose meacutesangiale focale et leacutesions ldquodiabeacutetoiumldesrdquo
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ME x2rsquo500 ME x2rsquo500
eacutepaississement focal de la membrane basale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x300
glomeacuterulomeacutegalie
Source Kambham et coll Kidney Int 2001
Glomeacuterulopathie lieacutee agrave lrsquoobeacutesiteacute
HSF idiopathique
Proteacuteinurie drsquoordre neacutephrotique 48 66
Syndrome neacutephrotique 56 54
Oedegravemes 35 68
Albumine seacuterique gl 39 29
cholesteacuterol seacuterique mgdl 229 335
Scleacuterose focale 10 39
Glomeacuterulomeacutegalie 100 10
Fusion podocytaire 40 75
ORG is distinct from idiopathic FSGS
ldquoObesity has not only been suggested to cause renal disease but also to
accelerate its deteriorationrdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Bonnet et coll Am J Kidney Dis 2000
ldquoIn a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA)
nephropathy the presence of an elevated BMI at RBI was significantly associated with the
severity of pathological renal lesionsrdquo
Maladie de Berger
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
ldquoIn the following years several case reports describing glomerulosclerosis in very
obese patients have been published but this entity was considered as rare and rather
bizarrerdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Metcalf et coll Clin Chem 1992
ldquoThe degree of albuminuria
showed piecewise log-linear relationship with body mass
index (P = 00001)rdquo
50
10
5
15
15
20 25 30 35 40 45 50
AlbuminmgL
Body mass index (kgm2)
5670 people older than 40 years
Source Iseki et coll Kidney Int 2004
0
375
75
1125
150
lt 210210-231
232-254255-
Total Men Women
N o
f ESR
D
BMI kgm2
Japon
Source Iseki et coll Kidney Int 2004
ldquoWe found that BMI was associated with an increased risk of the development of
end stage of renal disease in men in the general population in Okinawardquo
100rsquo753 screenees during follow-up 404 screenees developed ESRD
Japon
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoOverweight (BMI gt 25) at age 20 was associated with a significant three-fold excess risk for chronic renal failurerdquo
926 case patients and 998 control subjects
Suegravede
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoAfter mean follow-up of 185 years 244 participants (94) developed kidney disease Body mass index with odds ratio
123 (95 CI 108-141)rdquo
2rsquo585 participants with baseline and follow-up examination
Framingham Heart Study
Source Iseki et coll Kidney Int 2004
ldquoAfter an average 14-year follow-up 1rsquo377 participants (124) had a GFR less than 60 mL
min173 m2 Higher baseline BMI was associated consistently with increased
risk for CKD (OR 145)rdquo
11rsquo104 initially healthy men provided a blood sample after 14 years
PhysicianrsquoHealth Study
Source Stengel et coll Epidemiology 2003
ldquoThe study found that those with morbid obesity had more than double the risk of CKD (OR 23) compared to normal weight
individuals independent of age sex race smoking and physical activityrdquo
9rsquo082 adults with an average follow-up of 132 years
National Health and Nutrition Examination Survey (NHANES II)
Source Kramer et coll Am J Kidney Dis 2005
ldquoIn HDFP participants without CKD at baseline the incidence of CKD at year 5 was 28 in the ideal-body-mass-index group 31 in the overweight group (OR 121) and 34 in
the obese group (OR 140)rdquo
5rsquo897 hypertensive adults
Hypertension Detection and Follow-up Program (HDFP)
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ldquoORG was defined morphologically as focal segmental glomerulosclerosis and glomerulomegaly or glomerulomegaly
alonerdquo
6rsquo818 native renal biopsies
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x100 PAS x250
glomeacuteruloscleacuterose segmentaire et focale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x250
discregravete scleacuterose meacutesangiale focale et leacutesions ldquodiabeacutetoiumldesrdquo
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ME x2rsquo500 ME x2rsquo500
eacutepaississement focal de la membrane basale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x300
glomeacuterulomeacutegalie
Source Kambham et coll Kidney Int 2001
Glomeacuterulopathie lieacutee agrave lrsquoobeacutesiteacute
HSF idiopathique
Proteacuteinurie drsquoordre neacutephrotique 48 66
Syndrome neacutephrotique 56 54
Oedegravemes 35 68
Albumine seacuterique gl 39 29
cholesteacuterol seacuterique mgdl 229 335
Scleacuterose focale 10 39
Glomeacuterulomeacutegalie 100 10
Fusion podocytaire 40 75
ORG is distinct from idiopathic FSGS
ldquoObesity has not only been suggested to cause renal disease but also to
accelerate its deteriorationrdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Bonnet et coll Am J Kidney Dis 2000
ldquoIn a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA)
nephropathy the presence of an elevated BMI at RBI was significantly associated with the
severity of pathological renal lesionsrdquo
Maladie de Berger
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Metcalf et coll Clin Chem 1992
ldquoThe degree of albuminuria
showed piecewise log-linear relationship with body mass
index (P = 00001)rdquo
50
10
5
15
15
20 25 30 35 40 45 50
AlbuminmgL
Body mass index (kgm2)
5670 people older than 40 years
Source Iseki et coll Kidney Int 2004
0
375
75
1125
150
lt 210210-231
232-254255-
Total Men Women
N o
f ESR
D
BMI kgm2
Japon
Source Iseki et coll Kidney Int 2004
ldquoWe found that BMI was associated with an increased risk of the development of
end stage of renal disease in men in the general population in Okinawardquo
100rsquo753 screenees during follow-up 404 screenees developed ESRD
Japon
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoOverweight (BMI gt 25) at age 20 was associated with a significant three-fold excess risk for chronic renal failurerdquo
926 case patients and 998 control subjects
Suegravede
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoAfter mean follow-up of 185 years 244 participants (94) developed kidney disease Body mass index with odds ratio
123 (95 CI 108-141)rdquo
2rsquo585 participants with baseline and follow-up examination
Framingham Heart Study
Source Iseki et coll Kidney Int 2004
ldquoAfter an average 14-year follow-up 1rsquo377 participants (124) had a GFR less than 60 mL
min173 m2 Higher baseline BMI was associated consistently with increased
risk for CKD (OR 145)rdquo
11rsquo104 initially healthy men provided a blood sample after 14 years
PhysicianrsquoHealth Study
Source Stengel et coll Epidemiology 2003
ldquoThe study found that those with morbid obesity had more than double the risk of CKD (OR 23) compared to normal weight
individuals independent of age sex race smoking and physical activityrdquo
9rsquo082 adults with an average follow-up of 132 years
National Health and Nutrition Examination Survey (NHANES II)
Source Kramer et coll Am J Kidney Dis 2005
ldquoIn HDFP participants without CKD at baseline the incidence of CKD at year 5 was 28 in the ideal-body-mass-index group 31 in the overweight group (OR 121) and 34 in
the obese group (OR 140)rdquo
5rsquo897 hypertensive adults
Hypertension Detection and Follow-up Program (HDFP)
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ldquoORG was defined morphologically as focal segmental glomerulosclerosis and glomerulomegaly or glomerulomegaly
alonerdquo
6rsquo818 native renal biopsies
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x100 PAS x250
glomeacuteruloscleacuterose segmentaire et focale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x250
discregravete scleacuterose meacutesangiale focale et leacutesions ldquodiabeacutetoiumldesrdquo
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ME x2rsquo500 ME x2rsquo500
eacutepaississement focal de la membrane basale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x300
glomeacuterulomeacutegalie
Source Kambham et coll Kidney Int 2001
Glomeacuterulopathie lieacutee agrave lrsquoobeacutesiteacute
HSF idiopathique
Proteacuteinurie drsquoordre neacutephrotique 48 66
Syndrome neacutephrotique 56 54
Oedegravemes 35 68
Albumine seacuterique gl 39 29
cholesteacuterol seacuterique mgdl 229 335
Scleacuterose focale 10 39
Glomeacuterulomeacutegalie 100 10
Fusion podocytaire 40 75
ORG is distinct from idiopathic FSGS
ldquoObesity has not only been suggested to cause renal disease but also to
accelerate its deteriorationrdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Bonnet et coll Am J Kidney Dis 2000
ldquoIn a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA)
nephropathy the presence of an elevated BMI at RBI was significantly associated with the
severity of pathological renal lesionsrdquo
Maladie de Berger
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Iseki et coll Kidney Int 2004
0
375
75
1125
150
lt 210210-231
232-254255-
Total Men Women
N o
f ESR
D
BMI kgm2
Japon
Source Iseki et coll Kidney Int 2004
ldquoWe found that BMI was associated with an increased risk of the development of
end stage of renal disease in men in the general population in Okinawardquo
100rsquo753 screenees during follow-up 404 screenees developed ESRD
Japon
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoOverweight (BMI gt 25) at age 20 was associated with a significant three-fold excess risk for chronic renal failurerdquo
926 case patients and 998 control subjects
Suegravede
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoAfter mean follow-up of 185 years 244 participants (94) developed kidney disease Body mass index with odds ratio
123 (95 CI 108-141)rdquo
2rsquo585 participants with baseline and follow-up examination
Framingham Heart Study
Source Iseki et coll Kidney Int 2004
ldquoAfter an average 14-year follow-up 1rsquo377 participants (124) had a GFR less than 60 mL
min173 m2 Higher baseline BMI was associated consistently with increased
risk for CKD (OR 145)rdquo
11rsquo104 initially healthy men provided a blood sample after 14 years
PhysicianrsquoHealth Study
Source Stengel et coll Epidemiology 2003
ldquoThe study found that those with morbid obesity had more than double the risk of CKD (OR 23) compared to normal weight
individuals independent of age sex race smoking and physical activityrdquo
9rsquo082 adults with an average follow-up of 132 years
National Health and Nutrition Examination Survey (NHANES II)
Source Kramer et coll Am J Kidney Dis 2005
ldquoIn HDFP participants without CKD at baseline the incidence of CKD at year 5 was 28 in the ideal-body-mass-index group 31 in the overweight group (OR 121) and 34 in
the obese group (OR 140)rdquo
5rsquo897 hypertensive adults
Hypertension Detection and Follow-up Program (HDFP)
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ldquoORG was defined morphologically as focal segmental glomerulosclerosis and glomerulomegaly or glomerulomegaly
alonerdquo
6rsquo818 native renal biopsies
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x100 PAS x250
glomeacuteruloscleacuterose segmentaire et focale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x250
discregravete scleacuterose meacutesangiale focale et leacutesions ldquodiabeacutetoiumldesrdquo
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ME x2rsquo500 ME x2rsquo500
eacutepaississement focal de la membrane basale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x300
glomeacuterulomeacutegalie
Source Kambham et coll Kidney Int 2001
Glomeacuterulopathie lieacutee agrave lrsquoobeacutesiteacute
HSF idiopathique
Proteacuteinurie drsquoordre neacutephrotique 48 66
Syndrome neacutephrotique 56 54
Oedegravemes 35 68
Albumine seacuterique gl 39 29
cholesteacuterol seacuterique mgdl 229 335
Scleacuterose focale 10 39
Glomeacuterulomeacutegalie 100 10
Fusion podocytaire 40 75
ORG is distinct from idiopathic FSGS
ldquoObesity has not only been suggested to cause renal disease but also to
accelerate its deteriorationrdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Bonnet et coll Am J Kidney Dis 2000
ldquoIn a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA)
nephropathy the presence of an elevated BMI at RBI was significantly associated with the
severity of pathological renal lesionsrdquo
Maladie de Berger
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Iseki et coll Kidney Int 2004
ldquoWe found that BMI was associated with an increased risk of the development of
end stage of renal disease in men in the general population in Okinawardquo
100rsquo753 screenees during follow-up 404 screenees developed ESRD
Japon
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoOverweight (BMI gt 25) at age 20 was associated with a significant three-fold excess risk for chronic renal failurerdquo
926 case patients and 998 control subjects
Suegravede
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoAfter mean follow-up of 185 years 244 participants (94) developed kidney disease Body mass index with odds ratio
123 (95 CI 108-141)rdquo
2rsquo585 participants with baseline and follow-up examination
Framingham Heart Study
Source Iseki et coll Kidney Int 2004
ldquoAfter an average 14-year follow-up 1rsquo377 participants (124) had a GFR less than 60 mL
min173 m2 Higher baseline BMI was associated consistently with increased
risk for CKD (OR 145)rdquo
11rsquo104 initially healthy men provided a blood sample after 14 years
PhysicianrsquoHealth Study
Source Stengel et coll Epidemiology 2003
ldquoThe study found that those with morbid obesity had more than double the risk of CKD (OR 23) compared to normal weight
individuals independent of age sex race smoking and physical activityrdquo
9rsquo082 adults with an average follow-up of 132 years
National Health and Nutrition Examination Survey (NHANES II)
Source Kramer et coll Am J Kidney Dis 2005
ldquoIn HDFP participants without CKD at baseline the incidence of CKD at year 5 was 28 in the ideal-body-mass-index group 31 in the overweight group (OR 121) and 34 in
the obese group (OR 140)rdquo
5rsquo897 hypertensive adults
Hypertension Detection and Follow-up Program (HDFP)
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ldquoORG was defined morphologically as focal segmental glomerulosclerosis and glomerulomegaly or glomerulomegaly
alonerdquo
6rsquo818 native renal biopsies
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x100 PAS x250
glomeacuteruloscleacuterose segmentaire et focale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x250
discregravete scleacuterose meacutesangiale focale et leacutesions ldquodiabeacutetoiumldesrdquo
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ME x2rsquo500 ME x2rsquo500
eacutepaississement focal de la membrane basale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x300
glomeacuterulomeacutegalie
Source Kambham et coll Kidney Int 2001
Glomeacuterulopathie lieacutee agrave lrsquoobeacutesiteacute
HSF idiopathique
Proteacuteinurie drsquoordre neacutephrotique 48 66
Syndrome neacutephrotique 56 54
Oedegravemes 35 68
Albumine seacuterique gl 39 29
cholesteacuterol seacuterique mgdl 229 335
Scleacuterose focale 10 39
Glomeacuterulomeacutegalie 100 10
Fusion podocytaire 40 75
ORG is distinct from idiopathic FSGS
ldquoObesity has not only been suggested to cause renal disease but also to
accelerate its deteriorationrdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Bonnet et coll Am J Kidney Dis 2000
ldquoIn a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA)
nephropathy the presence of an elevated BMI at RBI was significantly associated with the
severity of pathological renal lesionsrdquo
Maladie de Berger
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoOverweight (BMI gt 25) at age 20 was associated with a significant three-fold excess risk for chronic renal failurerdquo
926 case patients and 998 control subjects
Suegravede
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoAfter mean follow-up of 185 years 244 participants (94) developed kidney disease Body mass index with odds ratio
123 (95 CI 108-141)rdquo
2rsquo585 participants with baseline and follow-up examination
Framingham Heart Study
Source Iseki et coll Kidney Int 2004
ldquoAfter an average 14-year follow-up 1rsquo377 participants (124) had a GFR less than 60 mL
min173 m2 Higher baseline BMI was associated consistently with increased
risk for CKD (OR 145)rdquo
11rsquo104 initially healthy men provided a blood sample after 14 years
PhysicianrsquoHealth Study
Source Stengel et coll Epidemiology 2003
ldquoThe study found that those with morbid obesity had more than double the risk of CKD (OR 23) compared to normal weight
individuals independent of age sex race smoking and physical activityrdquo
9rsquo082 adults with an average follow-up of 132 years
National Health and Nutrition Examination Survey (NHANES II)
Source Kramer et coll Am J Kidney Dis 2005
ldquoIn HDFP participants without CKD at baseline the incidence of CKD at year 5 was 28 in the ideal-body-mass-index group 31 in the overweight group (OR 121) and 34 in
the obese group (OR 140)rdquo
5rsquo897 hypertensive adults
Hypertension Detection and Follow-up Program (HDFP)
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ldquoORG was defined morphologically as focal segmental glomerulosclerosis and glomerulomegaly or glomerulomegaly
alonerdquo
6rsquo818 native renal biopsies
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x100 PAS x250
glomeacuteruloscleacuterose segmentaire et focale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x250
discregravete scleacuterose meacutesangiale focale et leacutesions ldquodiabeacutetoiumldesrdquo
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ME x2rsquo500 ME x2rsquo500
eacutepaississement focal de la membrane basale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x300
glomeacuterulomeacutegalie
Source Kambham et coll Kidney Int 2001
Glomeacuterulopathie lieacutee agrave lrsquoobeacutesiteacute
HSF idiopathique
Proteacuteinurie drsquoordre neacutephrotique 48 66
Syndrome neacutephrotique 56 54
Oedegravemes 35 68
Albumine seacuterique gl 39 29
cholesteacuterol seacuterique mgdl 229 335
Scleacuterose focale 10 39
Glomeacuterulomeacutegalie 100 10
Fusion podocytaire 40 75
ORG is distinct from idiopathic FSGS
ldquoObesity has not only been suggested to cause renal disease but also to
accelerate its deteriorationrdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Bonnet et coll Am J Kidney Dis 2000
ldquoIn a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA)
nephropathy the presence of an elevated BMI at RBI was significantly associated with the
severity of pathological renal lesionsrdquo
Maladie de Berger
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Ejerblad et coll J Am Soc Nephrol 2006
ldquoAfter mean follow-up of 185 years 244 participants (94) developed kidney disease Body mass index with odds ratio
123 (95 CI 108-141)rdquo
2rsquo585 participants with baseline and follow-up examination
Framingham Heart Study
Source Iseki et coll Kidney Int 2004
ldquoAfter an average 14-year follow-up 1rsquo377 participants (124) had a GFR less than 60 mL
min173 m2 Higher baseline BMI was associated consistently with increased
risk for CKD (OR 145)rdquo
11rsquo104 initially healthy men provided a blood sample after 14 years
PhysicianrsquoHealth Study
Source Stengel et coll Epidemiology 2003
ldquoThe study found that those with morbid obesity had more than double the risk of CKD (OR 23) compared to normal weight
individuals independent of age sex race smoking and physical activityrdquo
9rsquo082 adults with an average follow-up of 132 years
National Health and Nutrition Examination Survey (NHANES II)
Source Kramer et coll Am J Kidney Dis 2005
ldquoIn HDFP participants without CKD at baseline the incidence of CKD at year 5 was 28 in the ideal-body-mass-index group 31 in the overweight group (OR 121) and 34 in
the obese group (OR 140)rdquo
5rsquo897 hypertensive adults
Hypertension Detection and Follow-up Program (HDFP)
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ldquoORG was defined morphologically as focal segmental glomerulosclerosis and glomerulomegaly or glomerulomegaly
alonerdquo
6rsquo818 native renal biopsies
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x100 PAS x250
glomeacuteruloscleacuterose segmentaire et focale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x250
discregravete scleacuterose meacutesangiale focale et leacutesions ldquodiabeacutetoiumldesrdquo
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ME x2rsquo500 ME x2rsquo500
eacutepaississement focal de la membrane basale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x300
glomeacuterulomeacutegalie
Source Kambham et coll Kidney Int 2001
Glomeacuterulopathie lieacutee agrave lrsquoobeacutesiteacute
HSF idiopathique
Proteacuteinurie drsquoordre neacutephrotique 48 66
Syndrome neacutephrotique 56 54
Oedegravemes 35 68
Albumine seacuterique gl 39 29
cholesteacuterol seacuterique mgdl 229 335
Scleacuterose focale 10 39
Glomeacuterulomeacutegalie 100 10
Fusion podocytaire 40 75
ORG is distinct from idiopathic FSGS
ldquoObesity has not only been suggested to cause renal disease but also to
accelerate its deteriorationrdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Bonnet et coll Am J Kidney Dis 2000
ldquoIn a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA)
nephropathy the presence of an elevated BMI at RBI was significantly associated with the
severity of pathological renal lesionsrdquo
Maladie de Berger
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Iseki et coll Kidney Int 2004
ldquoAfter an average 14-year follow-up 1rsquo377 participants (124) had a GFR less than 60 mL
min173 m2 Higher baseline BMI was associated consistently with increased
risk for CKD (OR 145)rdquo
11rsquo104 initially healthy men provided a blood sample after 14 years
PhysicianrsquoHealth Study
Source Stengel et coll Epidemiology 2003
ldquoThe study found that those with morbid obesity had more than double the risk of CKD (OR 23) compared to normal weight
individuals independent of age sex race smoking and physical activityrdquo
9rsquo082 adults with an average follow-up of 132 years
National Health and Nutrition Examination Survey (NHANES II)
Source Kramer et coll Am J Kidney Dis 2005
ldquoIn HDFP participants without CKD at baseline the incidence of CKD at year 5 was 28 in the ideal-body-mass-index group 31 in the overweight group (OR 121) and 34 in
the obese group (OR 140)rdquo
5rsquo897 hypertensive adults
Hypertension Detection and Follow-up Program (HDFP)
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ldquoORG was defined morphologically as focal segmental glomerulosclerosis and glomerulomegaly or glomerulomegaly
alonerdquo
6rsquo818 native renal biopsies
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x100 PAS x250
glomeacuteruloscleacuterose segmentaire et focale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x250
discregravete scleacuterose meacutesangiale focale et leacutesions ldquodiabeacutetoiumldesrdquo
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ME x2rsquo500 ME x2rsquo500
eacutepaississement focal de la membrane basale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x300
glomeacuterulomeacutegalie
Source Kambham et coll Kidney Int 2001
Glomeacuterulopathie lieacutee agrave lrsquoobeacutesiteacute
HSF idiopathique
Proteacuteinurie drsquoordre neacutephrotique 48 66
Syndrome neacutephrotique 56 54
Oedegravemes 35 68
Albumine seacuterique gl 39 29
cholesteacuterol seacuterique mgdl 229 335
Scleacuterose focale 10 39
Glomeacuterulomeacutegalie 100 10
Fusion podocytaire 40 75
ORG is distinct from idiopathic FSGS
ldquoObesity has not only been suggested to cause renal disease but also to
accelerate its deteriorationrdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Bonnet et coll Am J Kidney Dis 2000
ldquoIn a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA)
nephropathy the presence of an elevated BMI at RBI was significantly associated with the
severity of pathological renal lesionsrdquo
Maladie de Berger
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Stengel et coll Epidemiology 2003
ldquoThe study found that those with morbid obesity had more than double the risk of CKD (OR 23) compared to normal weight
individuals independent of age sex race smoking and physical activityrdquo
9rsquo082 adults with an average follow-up of 132 years
National Health and Nutrition Examination Survey (NHANES II)
Source Kramer et coll Am J Kidney Dis 2005
ldquoIn HDFP participants without CKD at baseline the incidence of CKD at year 5 was 28 in the ideal-body-mass-index group 31 in the overweight group (OR 121) and 34 in
the obese group (OR 140)rdquo
5rsquo897 hypertensive adults
Hypertension Detection and Follow-up Program (HDFP)
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ldquoORG was defined morphologically as focal segmental glomerulosclerosis and glomerulomegaly or glomerulomegaly
alonerdquo
6rsquo818 native renal biopsies
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x100 PAS x250
glomeacuteruloscleacuterose segmentaire et focale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x250
discregravete scleacuterose meacutesangiale focale et leacutesions ldquodiabeacutetoiumldesrdquo
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ME x2rsquo500 ME x2rsquo500
eacutepaississement focal de la membrane basale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x300
glomeacuterulomeacutegalie
Source Kambham et coll Kidney Int 2001
Glomeacuterulopathie lieacutee agrave lrsquoobeacutesiteacute
HSF idiopathique
Proteacuteinurie drsquoordre neacutephrotique 48 66
Syndrome neacutephrotique 56 54
Oedegravemes 35 68
Albumine seacuterique gl 39 29
cholesteacuterol seacuterique mgdl 229 335
Scleacuterose focale 10 39
Glomeacuterulomeacutegalie 100 10
Fusion podocytaire 40 75
ORG is distinct from idiopathic FSGS
ldquoObesity has not only been suggested to cause renal disease but also to
accelerate its deteriorationrdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Bonnet et coll Am J Kidney Dis 2000
ldquoIn a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA)
nephropathy the presence of an elevated BMI at RBI was significantly associated with the
severity of pathological renal lesionsrdquo
Maladie de Berger
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Kramer et coll Am J Kidney Dis 2005
ldquoIn HDFP participants without CKD at baseline the incidence of CKD at year 5 was 28 in the ideal-body-mass-index group 31 in the overweight group (OR 121) and 34 in
the obese group (OR 140)rdquo
5rsquo897 hypertensive adults
Hypertension Detection and Follow-up Program (HDFP)
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ldquoORG was defined morphologically as focal segmental glomerulosclerosis and glomerulomegaly or glomerulomegaly
alonerdquo
6rsquo818 native renal biopsies
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x100 PAS x250
glomeacuteruloscleacuterose segmentaire et focale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x250
discregravete scleacuterose meacutesangiale focale et leacutesions ldquodiabeacutetoiumldesrdquo
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ME x2rsquo500 ME x2rsquo500
eacutepaississement focal de la membrane basale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x300
glomeacuterulomeacutegalie
Source Kambham et coll Kidney Int 2001
Glomeacuterulopathie lieacutee agrave lrsquoobeacutesiteacute
HSF idiopathique
Proteacuteinurie drsquoordre neacutephrotique 48 66
Syndrome neacutephrotique 56 54
Oedegravemes 35 68
Albumine seacuterique gl 39 29
cholesteacuterol seacuterique mgdl 229 335
Scleacuterose focale 10 39
Glomeacuterulomeacutegalie 100 10
Fusion podocytaire 40 75
ORG is distinct from idiopathic FSGS
ldquoObesity has not only been suggested to cause renal disease but also to
accelerate its deteriorationrdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Bonnet et coll Am J Kidney Dis 2000
ldquoIn a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA)
nephropathy the presence of an elevated BMI at RBI was significantly associated with the
severity of pathological renal lesionsrdquo
Maladie de Berger
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ldquoORG was defined morphologically as focal segmental glomerulosclerosis and glomerulomegaly or glomerulomegaly
alonerdquo
6rsquo818 native renal biopsies
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x100 PAS x250
glomeacuteruloscleacuterose segmentaire et focale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x250
discregravete scleacuterose meacutesangiale focale et leacutesions ldquodiabeacutetoiumldesrdquo
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ME x2rsquo500 ME x2rsquo500
eacutepaississement focal de la membrane basale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x300
glomeacuterulomeacutegalie
Source Kambham et coll Kidney Int 2001
Glomeacuterulopathie lieacutee agrave lrsquoobeacutesiteacute
HSF idiopathique
Proteacuteinurie drsquoordre neacutephrotique 48 66
Syndrome neacutephrotique 56 54
Oedegravemes 35 68
Albumine seacuterique gl 39 29
cholesteacuterol seacuterique mgdl 229 335
Scleacuterose focale 10 39
Glomeacuterulomeacutegalie 100 10
Fusion podocytaire 40 75
ORG is distinct from idiopathic FSGS
ldquoObesity has not only been suggested to cause renal disease but also to
accelerate its deteriorationrdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Bonnet et coll Am J Kidney Dis 2000
ldquoIn a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA)
nephropathy the presence of an elevated BMI at RBI was significantly associated with the
severity of pathological renal lesionsrdquo
Maladie de Berger
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x100 PAS x250
glomeacuteruloscleacuterose segmentaire et focale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x250
discregravete scleacuterose meacutesangiale focale et leacutesions ldquodiabeacutetoiumldesrdquo
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ME x2rsquo500 ME x2rsquo500
eacutepaississement focal de la membrane basale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x300
glomeacuterulomeacutegalie
Source Kambham et coll Kidney Int 2001
Glomeacuterulopathie lieacutee agrave lrsquoobeacutesiteacute
HSF idiopathique
Proteacuteinurie drsquoordre neacutephrotique 48 66
Syndrome neacutephrotique 56 54
Oedegravemes 35 68
Albumine seacuterique gl 39 29
cholesteacuterol seacuterique mgdl 229 335
Scleacuterose focale 10 39
Glomeacuterulomeacutegalie 100 10
Fusion podocytaire 40 75
ORG is distinct from idiopathic FSGS
ldquoObesity has not only been suggested to cause renal disease but also to
accelerate its deteriorationrdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Bonnet et coll Am J Kidney Dis 2000
ldquoIn a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA)
nephropathy the presence of an elevated BMI at RBI was significantly associated with the
severity of pathological renal lesionsrdquo
Maladie de Berger
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x250
discregravete scleacuterose meacutesangiale focale et leacutesions ldquodiabeacutetoiumldesrdquo
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ME x2rsquo500 ME x2rsquo500
eacutepaississement focal de la membrane basale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x300
glomeacuterulomeacutegalie
Source Kambham et coll Kidney Int 2001
Glomeacuterulopathie lieacutee agrave lrsquoobeacutesiteacute
HSF idiopathique
Proteacuteinurie drsquoordre neacutephrotique 48 66
Syndrome neacutephrotique 56 54
Oedegravemes 35 68
Albumine seacuterique gl 39 29
cholesteacuterol seacuterique mgdl 229 335
Scleacuterose focale 10 39
Glomeacuterulomeacutegalie 100 10
Fusion podocytaire 40 75
ORG is distinct from idiopathic FSGS
ldquoObesity has not only been suggested to cause renal disease but also to
accelerate its deteriorationrdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Bonnet et coll Am J Kidney Dis 2000
ldquoIn a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA)
nephropathy the presence of an elevated BMI at RBI was significantly associated with the
severity of pathological renal lesionsrdquo
Maladie de Berger
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
ME x2rsquo500 ME x2rsquo500
eacutepaississement focal de la membrane basale
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x300
glomeacuterulomeacutegalie
Source Kambham et coll Kidney Int 2001
Glomeacuterulopathie lieacutee agrave lrsquoobeacutesiteacute
HSF idiopathique
Proteacuteinurie drsquoordre neacutephrotique 48 66
Syndrome neacutephrotique 56 54
Oedegravemes 35 68
Albumine seacuterique gl 39 29
cholesteacuterol seacuterique mgdl 229 335
Scleacuterose focale 10 39
Glomeacuterulomeacutegalie 100 10
Fusion podocytaire 40 75
ORG is distinct from idiopathic FSGS
ldquoObesity has not only been suggested to cause renal disease but also to
accelerate its deteriorationrdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Bonnet et coll Am J Kidney Dis 2000
ldquoIn a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA)
nephropathy the presence of an elevated BMI at RBI was significantly associated with the
severity of pathological renal lesionsrdquo
Maladie de Berger
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Obesity-related glomerulopathy
Source Kambham et coll Kidney Int 2001
PAS x300PAS x300
glomeacuterulomeacutegalie
Source Kambham et coll Kidney Int 2001
Glomeacuterulopathie lieacutee agrave lrsquoobeacutesiteacute
HSF idiopathique
Proteacuteinurie drsquoordre neacutephrotique 48 66
Syndrome neacutephrotique 56 54
Oedegravemes 35 68
Albumine seacuterique gl 39 29
cholesteacuterol seacuterique mgdl 229 335
Scleacuterose focale 10 39
Glomeacuterulomeacutegalie 100 10
Fusion podocytaire 40 75
ORG is distinct from idiopathic FSGS
ldquoObesity has not only been suggested to cause renal disease but also to
accelerate its deteriorationrdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Bonnet et coll Am J Kidney Dis 2000
ldquoIn a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA)
nephropathy the presence of an elevated BMI at RBI was significantly associated with the
severity of pathological renal lesionsrdquo
Maladie de Berger
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Kambham et coll Kidney Int 2001
Glomeacuterulopathie lieacutee agrave lrsquoobeacutesiteacute
HSF idiopathique
Proteacuteinurie drsquoordre neacutephrotique 48 66
Syndrome neacutephrotique 56 54
Oedegravemes 35 68
Albumine seacuterique gl 39 29
cholesteacuterol seacuterique mgdl 229 335
Scleacuterose focale 10 39
Glomeacuterulomeacutegalie 100 10
Fusion podocytaire 40 75
ORG is distinct from idiopathic FSGS
ldquoObesity has not only been suggested to cause renal disease but also to
accelerate its deteriorationrdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Bonnet et coll Am J Kidney Dis 2000
ldquoIn a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA)
nephropathy the presence of an elevated BMI at RBI was significantly associated with the
severity of pathological renal lesionsrdquo
Maladie de Berger
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
ldquoObesity has not only been suggested to cause renal disease but also to
accelerate its deteriorationrdquo
Source Prof G Wolf Contribution to Nephrology 2006
Source Bonnet et coll Am J Kidney Dis 2000
ldquoIn a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA)
nephropathy the presence of an elevated BMI at RBI was significantly associated with the
severity of pathological renal lesionsrdquo
Maladie de Berger
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Bonnet et coll Am J Kidney Dis 2000
ldquoIn a cohort of 162 incident patients with biopsy-proven immunoglobulin A (IgA)
nephropathy the presence of an elevated BMI at RBI was significantly associated with the
severity of pathological renal lesionsrdquo
Maladie de Berger
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Meier-Kriesche et coll Transplantation 2002
ldquoBMI showed a very strong association with outcome after renal
transplantation BMI was also associated with an increased risk for delayed graft
functionrdquo51rsquo927 primary adult renal transplant registred in the USRDS
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Bergstroumlm et coll Br J Cancer 2001
363rsquo992 Swedish men
ldquoHigher body-mass index and elevated blood pressure independly increase the
long-term risk of renal-cell cancer in menrdquo
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
ldquoThe positive association between obesity and kidney
disease is a relationship that is both complex and not yet fully
understoodrdquo
Source Ting et coll Nephron Clin Pract 2009
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Kuiper JJ Nephron 1996
The interrelationship between adiposity and maladaptive changes in the heart and kidney
Dysfunctional adipose tissuebullMacrophage infiltrationbullLow-grade inflammationbullIncreased IL-1 IL-6 TNF-αbullElevated leptin
uarr Aldosteroneuarr Angiotensin II NADP oxydase ROS production
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Sowers et coll Cardiorenal Med 2011
HyperuricemiaSympathetic activation
RAAS activationOxydative stress
Inflammation
Microalbuminuria Hyperfiltration
progressing to
bullNa-retentionbullGlomerular sclerosisbullTubulointerstitial fibrosisbullProteinuria bullDecreased GFR
Endothelial dysfunction
Hyperfiltration-related maladaptive mechanisms
uarr ROS
NO uarrNOO-
darrBioavailable NOuarrPAI-1TPA (impaired fibrinolysis vasoconstriction)darrDelivery of glucose and insuline to tissues
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
ldquoGlomerular filtration rate (GFR) and renal plasma flow (RPF) were determined by measuring inulin and PAH clearance In the
obese group GFR exceeded the control value by 61 and RPF by 32 Consequently filtration
fraction (FF) was increasedrdquo
Source Chagnac et coll J Am Soc Nephrol 2003
(GFR)(RPF) = (FF)
Forces heacutemodynamiques
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Hall et coll Am J Med Sci 2002
Forces physiques
compression reacutenale extrinsegraveque et intrinsegraveque
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
ldquoAbnormal kidney function caused by increased renal tubular reabsorption initiates
volume expansion and increased blood pressure during excess weight gain and the hypertension
and metabolic abnormalities associated with obesity in turn contribute to chronic renal
diseaserdquo
Source Hall JE Hypertension 2003
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Hall JE Hypertension 2003
Obeacutesiteacute augmente reacuteabsorption tubulaire du sodium
uarrTubular NaClReabsorption
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
ldquoLes cytokines seacutecreacuteteacutes par le tissu adipeux (adipokines) induisent une hyperactiviteacute
sympathique par le biais de la leptine et un eacutetat inflammatoire de bas grade qui contribue
au deacuteveloppement de leacutesions de scleacuterose glomeacuterulaire drsquoautant qursquoil existe une reacutesistance
agrave lrsquoadiponectinerdquo
Source Prof M Laville Nephro Ther 2011
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Substances vasoactives et profibrosantesAngiotensine Rocircle important dans le deacuteveloppement et la progression de la neacutephropathie Effet sur lrsquohypertension intraglomeacuterulaire et la permeacuteabiliteacute seacutelective de la membrane basale glomeacuterulaire
Insuline Stimule la synthegravese facteurs de croissance tels que IGF-1 et 2 promoteurs probable drsquohypertrophie glomeacuterulaire Vasodilatation arteacuteriole affeacuterente augmentation hypertension intraglomeacuterulaire
Reacutenine Augmentation ainsi que lrsquoaldosteacuterone
Leptine Action pro-inflammatoires et profibrotique Rocircle dans la survenue de lrsquohypertension chez sujet obegravese Stimulation du systegraveme sympathique
Transforming growth factor-β (TGF-β) Augmentation
Tumor necrosis factor-α (TNF-α) Augmentation
Plasminogen activator inhibitor-1 (PAI-1) Augmentation
Interleukine-6 Augmentation
Reacutesistine Augmentation Insulinreacutesistance inflammation
Adiponectine Diminution sous lrsquoinfluence de la feacutetuine avec insulinoreacutesistance inflammation dysfonction endotheacuteliale stimulation SRAA et finalement HTA Reacutegulation permeacuteabiliteacute glomeacuterulaire
Source Mathieu et coll Rev Med Suisse 2006
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
vasoconstriction arteacuteriole affeacuterente
Source
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Effet sur arteacuteriole
Source Juncos et coll J Clin Invest 1993
insulin-induced vasodilatation
controlNENE +Insulin
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Hoshi and coll Lab Invest 2002
ldquoThe obese Zucker (ZDF-fafa) rat with has hyperinsulinaemia and
hyperlipidemia develops progressive renal failure associated with an accentuated
podocyte injury and glomerulosclerosisrdquorat Zucker porteur drsquoune mutation du gegravene de la leptine
leptine
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Correia et coll Curr Opin Nephrol Hypertension 2004
ldquoNormal rats infused with leptin developed proteinuria and focal
glomerulosclerosis Interactions between the activated RAAS and leptin appear to play an important role in oxidative stress within
endothelial cells and contribute to the pathogenesis of atherosclerosisrdquo
leptine
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Sharma et coll J Clin Invest 2008
ldquoAdiponectin (ADPN) whose levels are reduced in obesity and insulin resistance was
strongly implicated in the pathogenesis of kidney injury in
obesityrdquo
Adiponectine
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Sharma et coll J Clin Invest 2008
ldquoADPN-deficient mice exhibited effacement and fusion of podocyte
foot process as well as increased albuminuria Administration of ADPN led to attenuation in podocyte damage together with a
reduction in albuminuriardquo
Adiponectine
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source httpbouzouwordpresscom
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
ldquoLe traitement de choix des neacutephropathies associeacutees agrave lrsquoobeacutesiteacute est la reacuteduction du
poids corporelrdquo
Source Mathieu et coll Rev Med Suisse 2006
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Praga et coll Nephron 1995
ldquoThere was significant correlation between body weight loss and decrease in
proteinuriardquo
17 obese patients with proteinuria gt 1gday
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Ohashi et coll Nippon Jinzo Gakkai Shi 2001
ldquoIn a small Japanese case series 25 patients with BMI gt 25 who were hypertensive and microalbuminuric with preserved renal function were place in a low-caloric diet (25
kcalkg) with significant improvment in microalbumuria and blood pressure over 1-year
follow-up in the 12 patients who achieved a weight reduction of at least 5rdquo
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Kuiper JJ Nephron 1996
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Praga et coll Nephrol Dial Transplant 2001
ldquoEn preacutesence drsquoune hyperfiltration drsquoune hyperactiviteacute du SRAA a fortiori drsquoune
microalbuminurie ou drsquoune proteacuteinurie lrsquoadministration drsquoinhibiteur de lrsquoenzyme de conversion est logique Cependant leur effet sur la proteacuteinurie peut nrsquoecirctre que transitoire en lrsquoabsence de perte de poids stable ce qui limite
leur action neacutephroprotectricerdquo
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Fowler et coll Pediatr Nephrol 2009
ldquo17-year-old girl with morbid obesity (BMI 568) and ORG presenting with nephrotic range proteinuria who failed to improve following treatment with
diet exercise and ACEiARB therapy Laparoscopic gastric bypass surgery was
performed and within 2 weeks following the surgery the patient had lost 57 kg body weight and showed a remarkable decrease in protein excretion
to one tenth of pre-surgery levelsrdquo
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Tafti et coll Obes Surg 2009
ldquoObese patients with renal failure can safely undergo bariatric surgery and that
bariatric surgery may have a role in treating chronic kidney disease in select
morbidly obese patientsrdquo
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
copy Chappatte
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
ldquoBMI may not be ideal due to its inability to reliably distinguish visceral obesity from
subcutaneous fat nor is able to differentiate a high body weight due to muscle mass from fat
(or oedema)rdquo
Source Ting et coll Nephron Clin Pract 2009
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
ldquoMore studies are required to identify a more reliable measure of kidney
function in the obese but until then the use of non-corrected GFR in combination with
calibrated serum creatinine has been recommended in these individualsrdquo
Source Ting et coll Nephron Clin Pract 2009
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source R Stolic Med Hypotheses 2010
ldquoReverse epidemiology is a term for the medical hypothesis wich holds that the influence
of obesity and high body weight indexes may be protective and associated
with greater survival in obese patient in haemodialysisrdquo
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Source Kalantar-Zadeh et coll Mayo Clin Proc 2010
ldquoHigher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival even after
extensive multivariate adjustment for available surrogates of nutritional status and inflammation rdquo
5-year cohort of 121rsquo762 patients receiving HD 3xweek
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
Dr Vincent Bourquin - service de neacutephrologie - httpnephrohugcom
merci de votre attention
