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Figure 1. Obesity and kidney disease. Diagram shows relationships between components of the metabolic syndrome and the development of renal disease. DM2, type 2 diabetes mellitus, HTN, hypertension.
Figure 2. Microalbuminuria: Relationship to the metabolic syndrome. (A) Fifteen percent of the normal population has microalbuminuria. (B) Shows overlap of subsets of individuals who have obesity (OBS; 15 to 20%), hypertension (HTN; 5 to 40%), and diabetes (DM; 15 to 40%) and have microalbuminuria (yellow). This group is at increased risk for cardiovascular disease and renal disease, which is usually associated with insulin resistance/hyperinsulinemia.
Christine Abrass, MD
Tables
Table 1. Diabetes: Fetal origins of adult diseasea
Maternal Fetal Adult Offspring a Fetal exposure to nutritional disturbances affects pancreatic development and influences the insulin response in adulthood that becomes manifest as diabetes. Furthermore, these offspring have an increased rate of gestational diabetes, which in turn increases the risk for future development of type 2 diabetes in their offspring. In this manner, obesity may play a role in escalating the incidence of obesity and its associated diseases, including renal disease. Mild hyperglycemia Asymmetric macrosomia, ↑ insulin, ↑ IGF-1 Type 2 diabetes, normal pancreatic mass ↑ Risk for type 2 diabetes Gestational diabetes Islet hypertrophy and hyperplasia Impaired glucose tolerance, impaired insulin secretion, ↑ risk for breast cancer Severe hyperglycemia Asymmetric microsomia, ↓ insulin, ↓ IGF-1 Type 2 diabetes, ↑ pancreatic mass ↑ Risk for type 2 diabetes Poorly controlled diabetes ↓ Insulin receptors, degranulation of β cells Insulin resistance, ↑ insulin, cardiovascular disease and renal disease Protein restriction Reduced nephron number, ↓ insulin, ↓ pancreatic mass, ↓ β cells Type 2 diabetes, women are insulin resistant, hypertension ↑ Risk for type 2 diabetes Intrauterine growth retardation
Overview: Obesity: What Does It Have to Do with Kidney Disease?
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