Nefropatía de la obesidad
La obesidad constituye un factor independiente de riesgo para la aparición y progresión de daño renal y puede causar, por sí misma, insuficiencia renal terminal. La forma más conocida de afectación renal en la obesidad es la glomerulopatía de la obesidad, cuyo dato distintivo es la glomerulomegalia. Este aumento del volumen glomerular se acompaña en ocasiones de lesiones de glomeruloesclerosis segmentaria y focal (GSF). Aunque son varios los mecanismos patogénicos que participan en la glomerulopatía de la obesidad, uno de los más importantes es la hiperfiltración glomerular, característica de los sujetos obesos o con sobrepeso. La coexistencia de otras causas de hiperfiltración, como diabetes o reducción de masa renal, agrava los efectos perjudiciales de la obesidad.
En algunos pacientes puede desarrollarse proteinuria masiva, pero sin que se manifiesten los componentes típicos del síndrome nefrótico (edema, hipoalbuminemia). El tratamiento con inhibidores del sistema renina-angiotensina-aldosterona (SRAA) y la pérdida de peso, bien con dietas hipocalóricas o con cirugía bariátrica, son las únicas alternativas terapéuticas disponibles hoy en día. No obstante, no se han realizado estudios clínicos prospectivos con el tamaño suficiente como para demostrar de manera inequívoca su eficacia y un número significativo de casos desarrolla finalmente insuficiencia renal terminal. Por ello, la identificación de nuevos agentes terapéuticos es una necesidad médica de gran importancia.
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