肥胖相关性肾病的治疗进展

Progress in Treatment of Obesity-related Nephropathy

肥胖相关性肾病(ORG)是由肥胖引起的肾脏损害的一种类型,其发病机制包括肾血流动力学改变、肾素-血管紧张素-醛固酮系统(RAAS)的过度激活、胰岛素抵抗和脂肪因子紊乱、线粒体功能紊乱等。ORG的病理特征主要为肾小球和肾小管肥大、局灶节段性肾小球硬化。对于ORG患者,RAAS抑制剂短期内有效,但通过低热量饮食或减肥手术减轻体重具有更一致和长远的抗蛋白尿和逆转超滤过作用;此外,噻唑烷二酮类、双胍类等胰岛素增敏剂可减轻肾功能不全防止肾功能进一步恶化。未来,抗氧化剂和胰高血糖素样肽-1受体激动剂等将为ORG的治疗提供新思路。

Obesity-related nephropathy(ORG)is a type of kidney damage caused by obesity,the pathogenesis of which includes the changes of renal hemodynamics,the over-activation of the renin-angiotensin-aldosterone system(RAAS),the insulin resistance and the disorders of the adipokines,and the disorder of mitochondrial function.The main pathological features of ORG are hypertrophy of glomerulus and renal tubules and focal segmental glomerulosclerosis.For ORG patients,the RAAS inhibitor is effective in the short term,while a low-calorie diet or a weight-reducing operation has a more consistent and long-term anti-proteinuria and reversing ultrafiltration effect;in addition,the insulin sensitizers such as thiazolidinediones and biguanides can reduce the renal insufficiency and prevent the further deterioration of renal function.In the future,antioxidants and glucagon-like peptide-1 receptor agonists will provide new ideas for the treatment of ORG.