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Nefrologia clinica

The renal haemodynamics response to a meat meal is reduced and delayed in severe obesity

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Razionale

Little information is available about the tubular functions and the renal homeostatic adjustments after a protein meal in obese subjects. Whether hypertrophic adipose tissue or its classic co-morbidities may affect renal function and how the excess of fat may affect renal response to dietary proteins is currently partially understood. This paper aims to address whether (i) the adipocyte hypertrophy in obese patients, in the absence of other comorbidities, is responsible of kidney dysfunction, at either glomerular and tubular level and (ii) whether it compromises renal adaptations after a large protein meal.

Casistica e Metodi

Twenty obese subjects without comorbidities (non-albuminuric and non-hypertensive) and twenty control subjects have been studied. The glomerular filtration rate (GFR, inulin clearance), renal plasma flow (RPF, p-aminohippurate -PAH clearance), the proximal tubular function (Lithium clearance, CLi), the fractional excretion of sodium (FPRNa) has been measured at the basal level (steady state) and after a protein meal (perturbation).

Risultati

Under steady state conditions, the GFR, RPF, filtration fraction (FF), proximal tubular sodium handling and the FPRNa were not significantly different in non hypertensive non proteinuric obese subjects compared with controls. However, a protein meal led to a prolonged glomerular hyperfiltration in obese patients compared with controls, with an acute; a reduction of RPF, whereas control subjects increased the RPF after the perturbation. This modification of RPF after proteic meal was linearly correlated to the body mass index.

Conclusioni

This study shows that obese patients, in the absence of significant co-morbidities, have a normal GFR, RPF, and proximal tubule Na+ absorption at basal; conversely, these subjects showed a different response to a protein meal compared with normal subjects in term of changes of GFR and RPF. Overall, these results suggest that the modified hemodynamic response to a protein meal might be the earliest hallmark of future kidney dysfunction in obese subjects.

Anastasio P., Viggiano D., De Santo N., Capasso G.
(Department of Cardio-Thoracic and Respiratory Science, Second University of Naples, Naples, Italy)
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