The Kidney in Metabolic Syndrome

Abstract

Increasing epidemiologic evidence shows that obesity and metabolic syndrome (MS) are associated with increased risk of developing chronic kidney disease (CKD). Recent advances in the pathophysiology of obesity-related kidney disease indicate that hemodynamic factors, chronic inflammation, and abnormal lipid metabolism contribute to kidney injury. However, all components of MS, hypertension, atherogenic dyslipidemia, and type 2 diabetes mellitus (T2DM) may induce kidney damage. Children with severe obesity have increased prevalence of early kidney abnormalities, including hyperfiltration, albuminuria, and elevated early urinary biomarkers of kidney injury. Treatment of obesity through lifestyle modification is the mainstream of management of MS. If successful, it is typically associated with the reduction of all other MS cardiometabolic risk components. Pharmacological treatment with angiotensin converting enzyme inhibitors and bariatric surgery in case of severe obesity could provide long-term benefit by slowing the progression to CKD. Novel renoprotective agents, such as GLP-1 analogues and SGLT2 inhibitors need to be evaluated for clinical use in children and adolescents with MS.