Obesity in kidney disease: A heavyweight opponent

Table 1 Recent major multicenter studies regarding the impact of obesity and overweight on the incidence of kidney disease, renal function prognosis and patient survival

Cohort	Number of patients	Country	Result	Ref.
Dialysis patients	1957	Netherlands	Higher mortality with very high or low BMI (< 65 yr)	[157]
Kidney transplant	1810	Netherlands	Higher mortality and kidney graft failure	[158]
Native population	1924	Sweden	Higher Chronic Renal Failure	[13]
National Health and Nutrition Examination Survey III	5659	United States	Higher microalbuminuria with metabolic syndrome	[159]
Hipertension and obesity	4585	Spain	Higher risk of renal insufficiency	[160]
Native population	2585	United States	Higher risk of kidney disease	[12]
Native population	5403	Japan	Higher risk of proteinuria	[161]
Kidney transplant	51927	United States	Lower patient and graft survival. Higher chronic graft failure and delayed graft function	[162]

Table 2 Summary of the most important changes in the kidney during diabetes

Stages	Features
1 and 2	Hyperfiltration and renal hypertrophy
3	Microalbuminuria and hypertension as clinical features. As histological features: arteriolar hyalinosis, glomerular basement membrane thickening and mesangial matrix expansion
4 (Diabetic Ne phropathy)	Proteinuria, nephrotic syndrome and decreased GFR
5	End-stage renal disease

Adapted from Amann et al[150]. GFR: Glomerular filtration rate.