Obesity - a risk factor of renal pathology in patients with type 2 diabetes mellitus

Aim.
To study association between obesity and renal pathology in patients with type 2 diabetes mellitus (DM2).
Materials and methods.
The study included 106 patients with CD2 (41 men and 65 women) of mean age 60.0?7.0 years. Exclusion criteria wereduration of DM2 less than 5 years and manifest diabetic nephropathy (DN) (glomerular filtraton rate (GFR) below 60 ml/min/m2, albuminuria over2 g/24 hr). Anthropometric parameters measured included body mass index (BMI). Serum creatinine, uric acid, lipid spectrum, hormones of adiposetissue (leptin and adiponectin) were determined. Severity of renal pathology was estimated from GF and albumin excretion in urine. The patients were categorized into 2 groups: with obesity (BMI>=30 kg/m2) and without it (BMI<30 kg/m2).
Results.
Occurrence of microalbuminuria and proteinuria increased with the degree of obesity (p<0.05). Patients with BMI>=30 kg/m2 more frequently presented with disturbed intrarenal dynamics (hyperfiltration), elevated arterial pressure, and reduced LVLD level than patients with BMI<30 kg/m2. Leptin levels increased with BMI. All patients with proteinuria showed hyperleptinemia. 89% of the DM2 patients had hypoadiponectinemia. Adiponectin levels dropped in DN at the stage of microalbuminuria compared with control. Patients with DN at the stage of proteinuria exhibiteda rise in adiponectin.
Conclusion.
Patients with DM2 and obesity (BMI>=30 kg/m2) more frequently develop renal pathology than in the absence of obesity. It suggests anindependent role of obesity in the development of DN in addition to specific mechanisms of renal pathology intrinsic in DM. This effect of obesity ismediated through the enhancement of hemodynamic and metabolic disorders coupled to the negative influence of adipose tissue hormones.

obesity, type 2 diabetes mellitus, diabetic nephropathy, leptin, adiponectin

1. Кутырина И.М., Федорова Е.Ю. Вклад ожирения в поражение почек при сахарном диабете (экспериментальное исследование) // Сахарный диабет. - 2008. - № 2. - С. 8-10.

2. Шестакова М.В., Дедов И.И. Сахарный диабет и хроническая болезнь почек. - М.: Медицинское информационное агентство, 2009. - С. 415-426.

3. Masaomi N., Yuko I., Nobuteru U. In a type 2 diabetic nephropathy rat model, the improvement of obesity by a low calorie diet reduces oxidative/ carbonyl stress and prevents diabetic nephropathy // Nephrol. Dial. Transplant. - 2005. - 20. - Р. 2661-2669.

4. Kamari Y., Avni I., Grossman E. Adiponectin - a novel anti-atherogenic factor in the metabolic syndrome: mechanisms of action and therapeutic potential // Vascular. Disease. Prevention. - 2005. - 2. - Р. 107-114.

5. Tomic М., Poljicanin Т., Pavlic-Renar I. Obesity- a risk factor for microvascular and neuropathic complications in diabetes? // Diabetologia Croatica. - 2003. - T. 2, № 32. - Р. 73-78.

6. Boer I., Sibley S., Kestenbaum B. at all. Central obesity, incident microalbuminuria, and change in creatinine clearance in the epidemiology of diabetes interventions and complications study // J. Am. Soc. Nephrol. - 2007. - 18. - Р. 235-243.

7. Pinto-Sietsma S., Janssen W., Hillege H. et al. Urinary albumin excretion is associated with renal functional abnormalities in a nondiabetic population // J. Am. Soc. Nephrol. - 2000. - 11. - Р. 1882-1888.

8. Wolf G. (ed). Obesity and the Kidney. Contributions to Nephrology. Basel, Kager; 2006.

9. Ballermann B. A role for leptin in glomerulosclerosis? // Kidney International. - 1999. - 56. - Р. 1154-1155.

10. Tomaszewski М., Charchar F., Maric C. et al. Glomerular hyperfiltration: A new marker of metabolic risk // Kidney International. - 2007. - 71. - Р. 816-821.

11. Демидова Т.Ю., Селиванова А.В., Аметов А.С. Роль жировой ткани в развитии метаболических нарушений у больных сахарным диабе- том 2 типа в сочетании с ожирением // Тер. архив. - 2006. - 11. - С. 64-69.

12. Tschritter O., Fritsche A., Thamer C. Plasma adiponectin concentrations predict insulin sensitivity of both glucose and lipid metabolism // Diabetes. - 2003. - 52(2). - Р. 239-243.

13. Stejskal D., Ruzicka V., Adamovska S. Adiponectin concentrations as a criterion of metabolic controlin persons with type 2 diabetes mellitus? // Biomed. Papers. - 2003. - 147(2). - Р. 167-172.

14. Sharma K., Ramachandra S., Gang.Q. Adiponectin regulates albuminuria and podocyte function in mice // J. Clin. Invest. - 2008. - 118(5). - Р. 1645-1656.

15. Rexford S. Linking adiponectin to proteinuria // J. Clin. Invest. - 2008. - 118(5). - Р. 1619-1622.

16. Zoccali С., Mallamaci F. Obesity, diabetes, adiponectin and the kidney: a podocyte affair. Nephrol // Dial. Transplant. - 2008. - 23(12). - Р. 3767-3770.

17. Koshimura J., Fujita H., NaritaT. Urinary adiponectin excretion is increased in patients with overt diabetic nephropathy // Biochemical and biophysical research communications. - 2004. - 316(1). - Р. 165- 169.

18. Hirotaka K., Naoya I., Shunsuke G. Increased Serum High-Molecular- Weight Complex of Adiponectin in Type 2 Diabetic Patients with Impaired Renal Function // Am. J. Nephrol. - 2006. - 26. - Р. 476-482.

19. Fujita H., Morii T., Koshimura J. Possible relationship between adiponectin and renal tubular injury in diabetic nephropathy // Endocrine journal. - 2006. - 6. - Р. 745-752.

20. Ymauchi T., Kamon G., Waki H., et al. The fat derived hormone adiponectin reverses insulin resistance associated with both lipoatrophy and obesity // Nat. Med. - 2001. - 7. - Р. 941-946.

21. Saraheimo M., Forsblom C., Thorn L. Serum adiponectin and progression of diabetic nephropathy in patients with type 1 diabetes // Diabetes Care. - 2008. - 31(6) . - Р. 1165-1169.