Kidney Pathological Changes in Metabolic Syndrome: A Cross-sectional Study

Alexander, Mariam P.; Patel, Tejas; Farag, Youssef M.K.; Flórez, Adriana; Rennke, Helmut G.; Singh, Ajay K.

doi:10.1053/j.ajkd.2009.01.255

Cited by 98 publications

(79 citation statements)

References 47 publications

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“…The major glomerular histologic changes found in DN are mesangial expansion, glomerular basement membrane thickening, and glomerular sclerosis [7,8]. In contrast, arteriolar hyalinosis, one of the earliest vascular changes noted in diabetes, was not appreciated in patients with metabolic syndrome [9,10]. Faced with vast inter-individual differences in terms of "glomerular filtration rate (GFR) reduction" along the course of DN progression [11], it is crucial to relentlessly search for markers predicting DN early on, for integration into screening and preventive algorithms.…”

Section: Progression Of Dn Is Often Influenced By Various Factors Incmentioning

confidence: 99%

Predictors of diabetic nephropathy

Gaballa

Farag

2013

Open Medicine

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AbstractDiabetic nephropathy (DN) is a leading cause of morbidity and mortality in diabetic patients representing a huge health and economic burden. Alarming recent data described diabetes as an unprecedented worldwide epidemic, with a prevalence of ∼6.4% of the world population in 2010, while the prevalence of CKD among diabetics was approximately 40%. With a clinical field hungry for novel markers predicting DN, several clinical and laboratory markers were identified lately with the promise of reliable DN prediction. Among those are age, gender, hypertension, smoking, sex hormones and anemia. In addition, eccentric left ventricular geometric patterns, detected by echocardiography, and renal hypertrophy, revealed by ultrasonography, are promising new markers predicting DN development. Serum and urinary markers are still invaluable elements, including serum uric acid, microalbuminuria, macroalbuminuria, urinary liver-type fatty acid-binding protein (u-LFABP), and urinary nephrin. Moreover, studies have illustrated a tight relationship between obstructive sleep apnea and the development of DN. The purpose of this review is to present the latest advances in identifying promising predictors to DN, which will help guide the future research questions in this field. Aiming at limiting this paramount threat, further efforts are necessary to identify and control independent modifiable risk factors, while developing an integrative algorithm for utilization in DN future screening programs.

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Section: Progression Of Dn Is Often Influenced By Various Factors Incmentioning

confidence: 99%

Predictors of diabetic nephropathy

Gaballa

Farag

2013

Open Medicine

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“…Recent consensus definition for metabolic syndrome consists of elevated BP, dyslipidemia (low HDL cholesterol and elevated serum triglycerides), elevated fasting glucose (impaired fasting glucose or type 2 diabetes), and central obesity (9). Previous observational studies and their meta-analysis reported an association between metabolic syndrome and incident CKD, microalbuminuria, and proteinuria among different ethnic groups (10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Metabolic Syndrome, ESRD, and Death in CKD

Navaneethan

Schold

Kirwan

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Previous studies reported an association between metabolic syndrome , incident CKD, and proteinuria. This study examined the associations between metabolic syndrome and its components with ESRD and death among those patients with stages 3 and 4 CKD (estimated GFR=15-59 ml/min per 1.73 m 2 ).Design, setting, participants, & measurements Patients with stages 3 and 4 CKD (n=25,868) who had data relating to metabolic syndrome and were followed in our health care system were identified using an electronic medical record-based registry. Cox proportional hazards models and competing risk analyses were used to study the associations between metabolic syndrome, its components (elevated BP, low HDL cholesterol, elevated serum triglycerides, impaired glucose metabolism, and obesity), and all-cause mortality and ESRD while adjusting for demographics, comorbid conditions, use of relevant medications, and renal function.Results Sixty percent of the study population (n=15,605) had metabolic syndrome. In the multivariate-adjusted analysis, presence of metabolic syndrome was associated with an increased risk for ESRD (hazard ratio=1.33, 95% confidence interval=1.08, 1.64) but not death (hazard ratio=1.04, 95% confidence interval=0.97, 1.12) during a mean follow-up of 2.3 years. Among the individual components of metabolic syndrome, impaired glucose metabolism, elevated triglycerides, and hypertension were associated with increased risk for ESRD, whereas low HDL cholesterol and impaired glucose metabolism were associated with higher risk of death.Conclusions Presence of metabolic syndrome is associated with ESRD but not death in patients with stages 3 and 4 CKD.Clin J Am Soc Nephrol 8: 945-952, 2013.

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“…27 Histological examination of kidneys from elective nephrectomy specimens has shown that patients with metabolic syndrome have greater tubular atrophy, interstitial fibrosis, and arterial sclerosis than matched controls. 28 On the other hand, ectopic lipid accumulation, one of the major culprits to explain the relationship between abdominal obesity and insulin resistance, has been also found to involve kidneys, and this has been suggested as a putative mechanism for obesity-related renal disease. 29 For the present, while obesity has been included in the list of diseases proposed by the European Renal Association-European Dialysis and Transplant Association to code the primary etiology of renal disease in patients requiring dialysis or kidney transplantation, 30 the metabolic syndrome is not a recognized individual cause of end-stage CKD.…”

Section: Discussionmentioning

confidence: 99%