Monday, 4 November 2013

Obesity and Renal Disease

A. Obesity is defined as a medical condition of excess body fat has accumulated overtime, while overweight is a condition of excess body weight relatively to the height. According to the Body Mass Index(BMI), a BMI between 25 to 29.9 is considered over weight, while a BMI of over 30 is an indication of obesity. According to the statistic, 68% of American population are either overweight or obese.

B. Renal Disease
Renal or kidney disease is defined as a condition of damage of tiny structures in kidney called nephrons that can lead to abnormal function of kidney in moving waste with no symptoms as the disease progress slowly over years.

C. How do calculate your BMI index
BMI= weight (kg)/ height (m2)

D. How Obesity associates with Renal Disease
1. According to the study of "Mechanisms linking obesity, chronic kidney disease, and fatty liver disease: the roles of fetuin-A, adiponectin, and AMPK" by Ix JH, Sharma K. (Source from Division of Nephrology and Hypertension, Department of Medicine, University of California-San Diego/Veterans Affairs San Diego Healthcare System, CA 92093-0711, USA., J Am Soc Nephrol. 2010 Mar;21(3):406-12. Epub 2010 Feb 11), posted in PubMed, researchers found that Recent studies identify mechanisms common to both diseases linked through an interorgan communication orchestrated by fetuin-A and adiponectin. In liver and kidney, the energy sensor 5'-AMP activated protein kinase (AMPK) is pivotal to directing podocytes and hepatocytes to compensatory and potentially deleterious pathways, leading to inflammatory and profibrotic cascades culminating in end-organ damage. Regulation of these early upstream pathways may provide new therapeutic targets for these increasingly common sequelae of obesity.

2. In a study of "Biochemical study of oxidative stress markers in the liver, kidney and heart of high fat diet induced obesity in rats" by Noeman SA, Hamooda HE, Baalash AA. (Source from Medical Biochemistry Department, Faculty of Medicine, Tanta University, Egypt.,, Diabetol Metab Syndr. 2011 Aug 3;3(1):17), posted in PubMed, researchers found that high fat diet-induced obesity is accompanied by increased hepatic, heart, and renal tissues oxidative stress, which is characterized by reduction in the antioxidant enzymes activities and glutathione levels, that correlate with the increase in MDA and PCO levels in most tissues. This may probably contribute to the additional progression of obesity related problems.

3. In a study of "[Obesity and chronic kidney disease]".[Article in Russian] by Bondar' IA, Klimontov VV, Simakova AI., Ter Arkh. 2011;83(6):66-70, posted in PubMed, researchers indicated that Obesity and overweight are now characterized as epidemics. It is shown that body overweight is associated with functional and structural changes in the kidneys,..., A decrease of body weight following lifestyle modification or bariatric surgery leads to reduction in albuminuria and eliminates hyperfiltration in obese subjects. Thus, prevention and treatment of obesity may reduce CKD incidence in general population.

4. In abstract of in a study of "[Overweight and obesity--risk factors in the development and progression of renal disease]" [Article in Slovak], by Sebeková K, Klassen A, Bahner U, Heidland A. (Source from Vedecko-výskumná základna Slovenskej zdravotníckej univerzity, Ustav preventívnej a klinickej medicíny, Bratislava, Slovenská republika., Vnitr Lek. 2004 Jul;50(7):544-9.) researchers found that Obesity-related renal disease may be prevented/postponed by an early weight reduction, by dietary intervention combined with physical exercise. In the advanced stages of renal disease benefits of weight reduction are minimal. Concomitant administration of angiotensin-converting-enzyme inhibitors or angiotensin II receptor 1 blockers exerts antiproteinuric effects and thereby aid in retarding the disease progression. Aimed prevention and treatment of obesity represent a challenge for the healthcare system. The concerted action of physicians, patients and the public health authorities is needed.

5. In a study of "The role of obesity and its bioclinical correlates in the progression of chronic kidney disease" by Chalmers L, Kaskel FJ, Bamgbola O. (Source from Department of Pediatrics, Oklahoma University Health Science Center, Oklahoma City, OK 73104, USA, Adv Chronic Kidney Dis. 2006 Oct;13(4):352-64.), posted in PubMed, researchers found that Reduced fetal protein synthesis contributes to oxidative glomerular injury and impairment of renal morphogenesis. Thus, kidneys are poorly equipped to handle physiologic stress that may result from the rapid body growth and programmed metabolic dysfunction later in life. Finally, in order to minimize morbidity of obesity-related kidney disease, preventive strategy must include optimal maternal health care, promotion of healthy nutrition and routine physical exercise, and early detection of CKD.

6. Etc.

E. Treatments of Obesity and Renal Disease
1. According to the study of "The role of the primary care physician in managing early stages of chronic kidney disease" by Coritsidis GN, Linden E, Stern AS. (Source from Mount Sinai Services, Elmhurst Hospital Center, Elmhurst, NY., Postgrad Med. 2011 Sep;123(5):177-85), posted in PubMed, researchers indicated in abstract that Recent increases in obesity, diabetes, and hypertension, along with the aging of the US population..... Nephrology evaluation at this point is essential to facilitate timely preparation for care of end-stage renal disease through preemptive transplantation or planned transition to dialysis. In addition to stringent control of underlying hypertension and/or diabetes, mineral metabolic parameters (serum parathyroid hormone, phosphorus, calcium, and bicarbonate) in patients with advancing CKD should be managed closely to avoid adverse effects on the cardiovascular and skeletal systems.

2. In a study of "A quick guide to evidence-based chronic kidney disease care for the primary care physician" by Fox CH, Voleti V, Khan LS, Murray B, Vassalotti J. (Source from University of Buffalo, Buffalo, NY, USA., Postgrad Med. 2008 Jul 31;120(2):E01-6), posted in PebMed, researchers indicated that with the aging of the US population and the increase in hypertension, diabetes mellitus, and obesity, the prevalence of chronic kidney disease (CKD) is increasing in the United States,... there is limited knowledge and uptake of these guidelines because of their length and and complexity. Patients with CKD risk factors, hypertension, diabetes mellitus, cardiovascular disease, a family history of CKD, and those older than 60 years should be screened using 2 tests: 1) the estimated glomerular filtration rate and 2) the urinary albumin-creatinine ratio. These tests allow the diagnosis and stratification of CKD into 5 stages. This article synthesizes the key evidence-based behaviors and clinical action plan that primary care physicians can implement to treat CKD and its complications.

3. Etc.

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