课件：肥胖相关性肾病治疗新进展.ppt

D’Agati VD，ect. NATURE REVIEWS | NEPHROLOGY ,2016.75  * Mechanisms of kidney injury in the setting of obesity. Obesity, especially morbid obesity, can induce afferent vasodilation in order to augment glomerular filtration rate. Glomerular autoregulation might be impaired and elevated systemic blood pressures could then be transmitted to the glomerular capillaries leading to barotrauma. Glomerular capillary dilation might heighten susceptibility to barotrauma, and the need for podocytes to cover a larger surface area could lead to proteinuria.  * Figure 3 | Potential role of adipokines in the development of obesity-related glomerulopathy. In obesity, satiated fatcells facilitate adipose tissue expansion by secreting angiogenic and inflammatory adipokines such as angiopoietins,vascular endothelial growth factor (VEGF), and cathepsins. These adipokines promote stromal rearrangements,neovascularization and the formation of novel adipocytes from pericytes of the microvasculature. Angiogenesis and adipogenesis are intricately linked, and disturbed angiogenesis has been associated with diminished adipose tissue expandability. Systemically circulating adipokines might reach the kidney and have local effects on mesangial cells, podocytes, and tubular cells, promoting maladaptive responses to glomerular hyperfiltration and albuminuria. * 诊断ORG首先需要认识疾病,其次必须综合分析临床表现、实验室检查结果和形态学改变特点。因此,临床与病理相结合是诊断ORG的关键。归纳起来ORG患者首先必须是肥胖体形,其体重指数( BMI)应28 kg/m2,;其次有肾脏损害的临床表现,如蛋白尿、高血压等。 * 1998年WHO根据西方白种人为基础研究制定的肥胖标准，BMI超过30定义为肥胖 2002年中国肥胖问题工作组提出了我国成人适宜的BMI范围：BMI＜18.5为体重过低； 18.5～23.9为正常；24.0～27.9为超重；≥28为肥胖  * 腰围的测量指标分为世界卫生组织标准和中国指标，世界卫生组织的指标是男性腰围应小于95厘米，女性腰围应小于80厘米；中国的指标是男性腰围应小于85厘米，女性应小于80厘米，超过这个范围则为肥胖。 腰臀比是用腰围除以臀围的比值，亚洲人的标准是男性应小于0.9，女性应小于0.8，如果超出则为肥胖。 * * 减轻体重 肾小球高滤过是肥胖性肾病发生的重要环节，减轻体重可降低肾小球高滤过，改善肾小球损伤，显著降低蛋白尿水平。 减肥：肥胖是本病之源，故减肥是治疗的重中之重。如低热量饮食、加强运动、减肥药物、减肥手术等综合措施。其本身不仅可以使尿蛋白减少，延缓肾功能进展，而且还可以减轻许多相应的其他代谢紊乱。 * Morales, E.Am. J. Kidney Dis.2003，41, 319 * a RCT showed a mean weight loss o