title: Obesity and renal disease: not all fat is created equal and not all obesity is harmful to the kidneys.
abstract: The prevalence of obesity is increasing worldwide and contributes to many health problems, including kidney disease. Unexpectedly, 10-30% of obese individuals are apparently not at increased risk of metabolic diseases, e.g. type 2 diabetes, cardiovascular disease and risk of renal disease. Their phenotype is labeled 'metabolically healthy obesity'. In the search for mechanisms explaining this unexpected condition, a favourable type of body fat distribution with low insulin resistance and with low subclinical inflammation has been identified. Furthermore, signalling pathways have been found that distinguish between metabolically benign and malignant obesity. In addition, the important roles of fatty acids, adipokines and hepatokines were identified. These factors regulate insulin resistance and subclinical inflammation. Onset and evolution of chronic kidney disease (CKD) are affected by obesity. CKD also increases the risk of insulin resistance and subclinical inflammation, two pathways that play an important role in the pathogenesis of renal malfunction. This brief review summarizes novel insights, specifically how distinct body fat compartments (including perivascular and even renal sinus fat) may have an impact on progression of CKD.
authors.affiliation: Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany Institute of Diabetes Research and Metabolic Diseases, Tübingen, Germany German Center for Diabetes Research (DZD), Tübingen, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Stefan
authors.affiliation: Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany.
authors.forename: Ferruh
authors.initials: F
authors.lastname: Artunc
authors.affiliation: Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Heyne
authors.affiliation: Institute of Diabetes Research and Metabolic Diseases, Tübingen, Germany German Center for Diabetes Research (DZD), Tübingen, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Machann
authors.affiliation: Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany Institute of Diabetes Research and Metabolic Diseases, Tübingen, Germany German Center for Diabetes Research (DZD), Tübingen, Germany.
authors.forename: Erwin D
authors.initials: ED
authors.lastname: Schleicher
authors.affiliation: Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany Institute of Diabetes Research and Metabolic Diseases, Tübingen, Germany German Center for Diabetes Research (DZD), Tübingen, Germany.
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Häring
mesh_terms: D000273:Adipose Tissue / Q000378:metabolism*; D000818:Animals; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology* / Q000503:physiopathology*; D006801:Humans; D009765:Obesity / Q000150:complications*
keywords: chronic kidney disease; insulin resistance; metabolically healthy obesity; non-alcoholic fatty liver disease; subclinical inflammation