Manifestation of renal disease in obesity: pathophysiology of obesity-related dysfunction of the kidney

Figures & data

Table 1 Pathology in proteinuria of obesity, type 2 diabetes, focal sclerosis

	Glomerulus	Podocyte	Basement membrane	Mesangium
Obesity	Glomerulomegaly	Fusion, linear deposits	Thickened 2+	Increased 2+
Type 2 diabetes	No Change	Fusion	Thickened 3+	Increased 4+
Focal sclerosis	Epithelial Hyperplasia^Citation19	Fusion	Thickened 4+	Increased 3+

Table 2 Glomerular filtration barrier: Nephrin is assisted by oxidation of glucose fatty acid

	Glucose transport	Fatty acid disposal
Insulin	+	+*
Adiponectin	+	+*
Leptin	?	?
Resistin	?	−

Note:

* Promoted by metformin/acetyl l-carnitine.

Table 3 Adiponectin, leptin and resistin interact with insulin in liver, pancreas, and kidney

	Hepatic gluconeogenesis	Hepatic glycogenolysis	Glucose/fatty acid disposal	Pancreatic beta cell function	Renal tubular Na resorption/wasting
Insulin	Inhibits***	Inhibits	Activates*	Inhibits	+/−
Adiponectin	Inhibits***	Inhibits	Activates*	?	?/?
Leptin	?	?	?	Inhibits**	+ indirect/+ direct
Resistin	Activates	?	Inhibits**	Inhibits	?

Notes:

* Promoted by metformin/acetyl l-carnitine.

** Promoted by aldosterone.

*** Promoted by acetyl l-carnitine.

Table 4 Factors in blood levels of insulin and adipokines

	Obese	Lean	Renal dysfunction
Insulin	Increased	Decreased	Increased
Adiponectin	Decreased	Increased	Increased
Leptin	Increased	Decreased	Increased
Resistin	Increased	Decreased	Increased

Table 5 Mechanisms of hypertension in obesity

	CNS sympathetic stimulation	Vasodilates	Vasoconstricts
Insulin	+	+*	+ CNS
Adiponectin	−	+	?
Leptin	+	+	+
Endothelial dependant		+	−
Nonendothial dependant		−	+ CNS
Resistin	?	?	?

Note:

* Promoted by metformin.

Abbreviations: CNS, central nervous system.

Table 6 Obesity-related hypertension: Role of central nervous and adrenal mechanisms

Central nervous system: sympathetic stimulation Increased insulin via renin-angiotensin-aldosterone system Increased leptin via renin-angiotensin-aldosterone system White adipose Local renin-angiotensin-aldosterone system Mineralocorticoid releasing factors stimulating adrenal secretion Oxygenated fatty acid (linoleic) stimulating adrenal secretion Absence of vasodilatory effect of adiponectin

StilmantMCrescenteric glomerulonephritis Chapter 3, page 40 in Pathology of Glomerular DiseaseRosenSeymourChurchill-LivingstonNew York1983

 Google Scholar