The effect of weight loss in obesity and chronic kidney disease.

Several epidemiologic investigations have confirmed that obesity is a significant risk factor for the appearance of proteinuria and end-stage kidney disease in a normal population. Weight loss induced by low-calorie diets, physical exercise, or bariatric surgery is accompanied by an important antiproteinuric effect. Reduction in proteinuria is already observed after a few weeks from the onset of weight loss and it is evident even in patients with modest weight losses. Reduction in proteinuria by weight loss has been described in chronic proteinuric nephropathies of different etiologies. The mechanisms through which weight loss may reverse proteinuria are likely to be plural: better control of blood pressure, improvement of serum lipid profile, improvement of insulin sensitivity, better glycemic control in diabetes patients, decrease of circulating leptin levels, reversal of glomerular hyperfiltration, and decreased activation of the renin-angiotensin-aldosterone system.