Obesity and Kidney Disease.

Obesity is a systemic disease of the white adipose tissue, which has evolved into a global epidemic. It is associated with a plethora of adipocyte hormonal (adipokine) imbalances, dysregulation of the energy-balance system, imbalances in metabolic homeostasis, a pro-inflammatory state and multiple target organ damages. Clinically, the obesity phenotype is not homogenous and is more likely to represent a spectrum with varying degrees of metabolic un-health; metabolically-unhealthy obesity is often a part of the metabolic syndrome. The links between obesity and chronic kidney disease are numerous, bidirectional, multi-layered and complex; this complexity may be explained by shared pathophysiological pathways (e.g. chronic inflammation, increased oxidative stress, and hyper-insulinemia), shared clusters of risk factors as well as associated diseases (e.g. insulin resistance, hypertension and dyslipidemia). We will review these links and their clinical manifestations, and offer a summary of available non-pharmacological as well as pharmacological therapeutic strategies.