Renal Disease in Metabolic Syndrome: the Hidden Role of Intrarenal Ischemia.

Abstract

Introduction:

The pathogenesis of renal disease in obesity and metabolic syndrome (MS) is mostly unknown. This is in part because of the limited information about renal morphological changes in these conditions. We evaluated renal histology in subjects with MS and those without MS, who are participants in the European Nephrectomy Biobank (ENBiBA) project.

Methods:

MS was defined with at least 3 of the following criteria: (i) body mass index (BMI) ≥27 kg/m2; (ii) prediabetes: fasting glucose of 100-125 mg/dl or HbA1c >5.7%; (iii) systolic or diastolic blood pressure >140/90 mm Hg or the use of medications; and (iv) triglycerides >150 mg/dl or high-density lipoprotein cholesterol <40 (in men) or 50 mg/dl (in women). The absence of these criteria defined patients without MS. Exclusion criteria were diabetes or known causes of renal disease.

Results:

A total of 157 cases were evaluated: 49 without and 108 with MS. Those with MS were older (54 ± 16 vs. 66 ± 11, P < 0.0001), had more prevalent chronic kidney disease (CKD, estimated glomerular filtration rate [eGFR] <60 ml/min): 24% (23%) versus 4% (8%) (P = 0.02), and had higher albumin-to-creatinine ratio (10 [4-68] vs. 4.45 [0-27], P = 0.05) than those without MS. Global sclerosis (3% [1-7] vs. 7% [3-13], P < 0.0001), nodular sclerosis, mesangial expansion, glomerulomegaly; moderate + severe hyalinosis, and arteriosclerosis were more frequent in those with MS than in those without (88 [82] vs. 29 [59]; 83 [77] vs. 30 [61]; P < 0.05). These vascular changes were independent of differences in age.

Conclusion:

In MS, ischemic renal disease may play a role in renal disease. In addition, some patients may develop lesions compatible with diabetic nephropathy such as increased mesangial expansion and nodular sclerosis. Further analyses are needed to study the consequences of the pandemic of obesity on renal health.

• Authors: Rosa Rodríguez-Rodríguez, Mads Hornum, Ana Elena Rodríguez Rodríguez, Sebastjan Bevc, Francesco Trevisani, Gema Fernández, Radovan Hojs, Beatriz Fernández-Fernández, Clara María Cases Corona, Josep María Cruzado, María Quero, Maruja Navarro Díaz, Arianna Bettiga, Francisco Moreso, Clara García Carro, Khaled Khazim, Fedaa Ghanem, Meritxell Ibernón, Ivo Laranjinhia, Luís Mendonça, Miguel Bigotte Vieira, Bo Feldt-Rasmussen, Alberto Ortiz, Per Bagi, Cristian Acosta Sorensen, Enrique Morales, Esteban Porrini, DIABESITY working group of the European Renal Association
• Journal: Kidney international reports (Kidney Int Rep) Vol. 9 Issue 5 Pg. 1419-1428 (May 2024) ISSN: 2468-0249 [Electronic] United States
• PMID: 38707823 (Publication Type: Journal Article)
• Copyright: © 2024 Published by Elsevier, Inc., on behalf of the International Society of Nephrology.