Metabolic syndrome and chronic kidney disease

Abstract

Patients with metabolic syndrome are at greater risk of developing type 2 diabetes and cardiovascular disease. Recently, it has been revealed that they are also at an increased risk of chronic renal disease. Release of adipocytokines leads to endothelial dysfunction. There are also activation of systemic and local renin-angiotensin-aldosterone system, oxidative stress, and impaired fibrinolysis. This leads to glomerular hyperfiltration, proteinuria, focal segmental glomerulosclerosis, and ultimately end-stage renal disease. Correcting the abnormalities of the metabolic syndrome should be part of the strategy for the prevention and management of chronic kidney disease. Treatment consists of lifestyle modifications along with optmal control of blood pressure, blood sugar and lipids. Metformin and thiazolidinediones reduce insulin resistance, while angiotensin-converting enzyme inhibitors and angiotensin receptor blockers reduce proteinuria and have a renoprotective effect. Exciting new medical therapies include a cannabinoid receptor type 1 antagonists, soy protein, and peroxisome proliferator-activated receptor agonists.