Proteinuria and focal segmental glomerulosclerosis in severely obese adolescents

Adelman, Raymond D.; Restaino, Irene; Alon, Uri; Blowey, Douglas L.

doi:10.1067/mpd.2001.113006

Cited by 139 publications

(115 citation statements)

References 26 publications

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“…Accordingly, microalbuminuria might be an early marker of type 2 diabetes as well as diabetic nephropathy. Previously, focal segmental glomerulosclerosis has been reported in obese children (31), and the possibility of fatty kidney disease analogous to nonalcoholic fatty liver disease and of whether obese youth without diabetes should be screened for microalbuminuria deserve further study. In our study, the higher prevalence of elevated ACR in youth with type 2 diabetes remained significant after controlling for potential risk factors with differential distribution between type 2 and type 1 diabetes cases (Fig.…”

Section: Methodsmentioning

confidence: 99%

Higher Prevalence of Elevated Albumin Excretion in Youth With Type 2 Than Type 1 Diabetes

et al. 2007

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OBJECTIVE -To estimate the prevalence of an elevated albumin-to-creatinine ratio (ACR) (Ն30 g/mg) among youth with type 1 or type 2 diabetes and to identify factors associated with elevated ACR and their effect on the relationship between elevated ACR and type of diabetes. RESEARCH DESIGN AND METHODS-Cross-sectional data were analyzed from 3,259 participants with onset of diabetes at Ͻ20 years of age in the SEARCH for Diabetes in Youth, a multicenter observational study of diabetes in youth. Multiple logistic regression was used to explore determinants of elevated ACR and factors accounting for differences in this prevalence between type 2 and type 1 diabetes.RESULTS -The prevalence of elevated ACR was 9.2% in type 1 and 22.2% in type 2 diabetes (prevalence ratio 2.4 [95% CI 1.9 -3.0]; P Ͻ 0.0001). In multiple logistic regression analysis, female sex, A1C and triglyceride values, hypertension, and type of diabetes (type 2 versus type 1) were significantly associated with elevated ACR. Adjustment for variables related to insulin resistance (obesity, hypertension, dyslipidemia, and inflammation) attenuated, but did not completely explain, the association of diabetes type with elevated ACR.CONCLUSIONS -Youth with type 2 diabetes have a higher prevalence of elevated ACR than youth with type 1 diabetes, in an association that apparently does not completely depend on age, duration of diabetes, race/ethnicity, sex, level of glycemic control, or features of insulin resistance. Diabetes Care 30:2593-2598, 2007R eports of type 1 and type 2 diabetes are becoming more common in youth (1,2), but little is known about whether the burden and risk factors for diabetes-related complications differ by type of diabetes in youth. An abnormal concentration of albumin in the urine is one of the earliest forms of clinical evidence of nephropathy, and microalbuminuria predicts progression to diabetic nephropathy (3) and cardiovascular disease (4). Current recommendations of the American Diabetes Association are to screen for microalbuminuria once a child is 10 years old and has had type 1 diabetes for 5 years and to screen children with type 2 diabetes at diagnosis and annually thereafter. Two of three values must be abnormal before the clinical diagnosis can be made, due to variability in albumin excretion rates (5). A spot urine early in the morning measuring the albumin-tocreatinine ratio (ACR) is one such screeni n g m e t h o d ( 5 ) , a n d r e p e a t e d abnormalities are required to clinically diagnose albuminuria.While an extensive literature exists on microalbuminuria and elevated ACR in children and adolescents with type 1 diabetes (6 -15), and diabetic nephropathy is well described in adults with type 2 diabetes (16), little data exist in youth with type 2 diabetes (17-20). Recently, clinical features of insulin resistance were found to be predictive of incident microalbuminuria among youth with type 1 diabetes (21). In adults, microalbuminuria is a component of the World Health Organization's definition of the metabolic s...

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Section: Methodsmentioning

confidence: 99%

Higher Prevalence of Elevated Albumin Excretion in Youth With Type 2 Than Type 1 Diabetes

et al. 2007

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“…The classic pathology features include glomerulomegaly and lesions of focal and segmental sclerosis involving the perihilar regions with associated hyalinosis and mesangial changes but with little tubulointerstitial damage. There tends to be less diffuse foot process effacement on electron microscopy than that seen in patients with primary FSGS (30)(31)(32). Risk factors identified by physiological studies that may contribute to the development of the lesion include elevations of renal plasma flow and GFR, insulin resistance leading to an increased transcapillary pressure gradient and increased synthesis of growth factors promoting glomerular hypertrophy (33,34).…”

Section: Obesity and Fsgsmentioning

confidence: 99%

Glomerular Diseases

Bose

Cattran

2014

Clinical Journal of the American Society of Nephrology

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SummaryFSGS is a lesion, not a disease. The separation into primary FSGS (a result of immunologic-mediated injury) versus secondary FSGS (related to a variety of causes) is often difficult. Even when this particular issue is carefully evaluated, the therapeutic implications are not always apparent. Newer literature on both biomarker discovery and on the genetic basis of FSGS is reviewed in this context. In addition, the thorny implications of obesity as it relates to the FSGS lesion are discussed. An overall practical algorithmic approach to the management and treatment of the FSGS lesion that integrates these controversial overlap areas is suggested.

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“…Obesity has been shown to reduce the glomerular filtration rate via the development of hyperfiltration, proteinuria, and focal segmental glomerulosclerosis. [57][58][59] Glomerulosclerosis often is seen in obese patients with end-stage renal disease due to the raised levels of tumor necrosis factor α, which in itself is a consequence of the inflammation often accompanying obese patients. The proinflammatory adipokines leptin and interleukin 6 also contribute to the development of glomerulosclerosis, via thinning of the glomerular basement membrane, ultimately resulting in allograft loss.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2016

Exp Clin Transplant

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Objectives: The prevalence of obesity is increasing rapidly and globally, yet systemic reviews on this topic are scarce. Our meta-analysis and systemic review aimed to assess how obesity affects 5 postoperative outcomes: biopsy-proven acute rejection, patient death, allograft loss, type 2 diabetes mellitus after transplant, and delayed graft function. Materials and Methods: We evaluated peer-reviewed literature from 22 medical databases. Studies were included if they were conducted in accordance with the Meta-analysis of Observational Studies in Epidemiology criteria, only examined postoperative outcomes in adult patients, only examined the relation between recipient obesity at time of transplant and our 5 postoperative outcomes, and had a minimum score of > 5 stars on the Newcastle-Ottawa scale for nonrandomized studies. Reliable conclusions were ensured by having our studies examined against 2 internationally known scoring systems. Obesity was defined in accordance with the World Health Organization as having a body mass index of > 30 kg/m 2 . All obese recipients were compared versus "healthy" recipients (body mass index of 18.5-24.9 kg/m 2 ). Hazard ratios were calculated for biopsy-proven acute rejection, patient death, allograft loss, and type 2 diabetes mellitus after transplant. An odds ratio was calculated for delayed graft function. Results: We assessed 21 retrospective observational studies in our meta-analysis (N = 241 381 patients). In obese transplant recipients, hazard ratios were 1.51 (95% confidence interval, 1.24-1.78) for presence of biopsy-proven acute rejection, 1.19 (95% confidence interval, 1.10-1.31) for patient death, 1.54 (95% confidence interval, 1.38-1.68) for allograft loss, and 1.01 (95% confidence interval, 0.98-1.07) for development of type 2 diabetes mellitus. The odds ratio for delayed graft function was 1.81 (95% confidence interval, 1.51-2.13). Conclusions: Our meta-analysis clearly demonstrated greater risks for obese renal transplant recipients and poorer postoperative outcomes with obesity. We confidently recommend renal transplant candidates seek medically supervised weight loss before transplant.

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Proteinuria and focal segmental glomerulosclerosis in severely obese adolescents

Cited by 139 publications

References 26 publications

Higher Prevalence of Elevated Albumin Excretion in Youth With Type 2 Than Type 1 Diabetes

Higher Prevalence of Elevated Albumin Excretion in Youth With Type 2 Than Type 1 Diabetes

Glomerular Diseases

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