Blood Pressure and Diabetic Nephropathy

Abstract

This is the fourth of a series of articles based on presentations at the American Diabetes Association Scientific Sessions held 5–9 June 2009 in New Orleans, Louisiana, pertaining to blood pressure and renal disease in diabetes. ### Diabetic nephropathy and obesity At the Clinical Update in Diabetic Nephropathy at the American Diabetes Association Scientific Sessions, Karen A. Griffin (Maywood, IL) discussed interrelationships between obesity and the kidney, noting that obesity appears to be related to the increase in end-stage renal disease (ESRD), in part because of its relationship to diabetes and hypertension, but with a 1.2-to 1.6-fold increase in chronic kidney disease (CKD) risk even correcting for these associations. Reviewing CKD staging, in stages 3, 4, and 5, the glomerular filtration rate (GFR) is 30–59, 15–29, and <15 ml/min per 1.73 m2 BSA, respectively, and Griffin pointed out that the adjustment for body surface is quite important when considering the effect of body size. In a Kaiser Permanente analysis of 1,471 subjects developing ESRD in a 8,347,955 person-year follow-up, adjusted for age, sex, race, education, cigarette use, diabetes, blood pressure, lipids, and other variables, obesity increased the likelihood of ESRD with BMI ≥35 associated with a 5-fold increase, BMI 30–34.9 associated with a 3-fold increase, and BMI 25–29.9 associated with a 1.5-fold increase in risk (1). There are a number of different forms of obesity-related CKD, with the majority of cases associated with microalbuminuria, endothelial dysfunction, and mild-to-moderate decrease in GFR, mainly associated with cardiovascular risk. Coexistent obesity and CKD lead, however, to accelerated progression of the latter (2,3). A form of glomerulopathy occurs with obesity characterized by glomerular enlargement (which is more common in obesity) and focal segmental glomerulosclerosis (4). The pathogenesis may involve hyperfiltration, leading to glomerular capillary injury and sclerosis, in a fashion similar to occurring experimentally with 5/6 …