Obesidade e doença renal: aspectos fisiopatológicos
DOI:
https://doi.org/10.34019/1982-8047.2018.v44.13982Keywords:
Obesidade, Doença Renal Crônica, Glomeruloesclerose Segmentar e Focal, Síndrome Metabólica, SobrepesoAbstract
A epidemia de obesidade observada nas últimas décadas é acompanhada de aumento exponencial de doenças crônicas relacionadas, com destaque diabetes mellitus tipo 2, hipertensão arterial sistêmica, dislipidemia e doenças cardiovasculares. Do mesmo modo, a obesidade constitui fator de risco independente para o desenvolvimento de doença renal crônica, condição associada a elevados índices de morbidade e de mortalidade. A obesidade causa lesão renal de maneira indireta, por meio de sua estreita associação com hipertensão arterial sistêmica e com diabetes mellitus tipo 2 e de maneira direta, ao induzir adaptações glomerulares que culminam na glomerulopatia específica da obesidade. Além disso, o excesso de peso contribui para o agravamento de glomerulopatias pré-existentes. Múltiplos fatores explicam o desenvolvimento e o agravamento das lesões renais associadas à obesidade, em especial alterações hemodinâmicas, inflamatórias e metabólicas. Nesse contexto, a redução do peso corporal com ênfase nas alterações metabólicas e inflamatórias bem como o tratamento da hipertensão arterial e do diabetes mellitus constituem o primeiro passo para a prevenção primária e secundária do desenvolvimento de doença renal crônica. Nesta revisão serão apresentados os principais mecanismos fisiopatológicos da lesão renal associada à obesidade.
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