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Obesity and Renal Risks

The obesity epidemic is growing fast in the United States and in the rest of the world. During the late 1990s, obesity increased dramatically to approximately one-third of all adults diagnosed as obese (with a BMI of more than 30 kg/m) at the end of the decade. Overweight has become a major global health problem due to its strong association with diseases such as hypertension, diabetes mellitus, atherosclerosis, hyperlipidaemia, colon cancer, osteoarthritis, and coronary artery disease, consequently also causing early disability and death. Recently, renal risks have been associated with obesity, particularly its relation with initiation and evolution of renal disease, hypertension, and potential impact on the outcome of various renal replacement modalities.

It has been shown that obesity and hypertension are closely related. Obesity alone accounts for 78 percent of essential hypertension in men, and 65 percent in women. A diet high in fat constantly causes increase of sodium reabsorption by kidneys, as weight loss produces urinary sodium excretion. Also, obesity is associated with other conditions that contribute to sodium reabsorption, such as the activation of RAS, hyperinsulinaemia and increased sympathetic nervous system activity. This is due mainly because of the lowered renal vascular resistance of an obese individual, along with an elevated kidney plasma flow, an increased GFR, and high blood pressure.

Overweight people with solitary kidney (nephrectomy or unilateral renal agenesis) or IgA nephropathy have a faster progression, especially if they have hypertension or hyperlipidaemia. Obesity might also be a cause of the evolution of renal disease in type 2 diabetes mellitus. Overweight is also associated with an increased risk of renal cell carcinoma, coronary and cerebral vascular disease. Additionally, a lower patient survival has been reported in obese renal allograft recipients than in patients with a lower BMI.

Overweight and obesity are often ignored renal risk factors. These conditions play a major role in the genesis and evolution of hypertension, focal and segmental glomerulosclerosis, and renal cell carcinoma. In regards to obesity, it is always better to prevent it than treat it. Therefore, lifestyle and eating habits should be encouraged in order to control the overweight epidemic and reduce the afflictions of obesity-related health conditions.

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