DOI QR코드

DOI QR Code

Research Related to Chronic Kidney Disease in BMI >25 Overweight Children

체질량 지수 25 이상의 과체중군에서 신장질환과 관련된 인자들에 대한 연구

  • Choi, Ah-Reum (Department of Pediatrics, College of Medicine, Kyunghee University) ;
  • Park, Sung-Sin (Department of Pediatrics, College of Medicine, Kyunghee University) ;
  • Kim, Sung-Do (Department of Pediatrics, College of Medicine, Kyunghee University) ;
  • Cho, Byoung-Soo (Department of Pediatrics, College of Medicine, Kyunghee University)
  • 최아름 (경희대학교 의과대학 소아과학교실) ;
  • 박성신 (경희대학교 의과대학 소아과학교실) ;
  • 김성도 (경희대학교 의과대학 소아과학교실) ;
  • 조병수 (경희대학교 의과대학 소아과학교실)
  • Published : 2009.04.30

Abstract

Purpose : Chronic kidney disease (CKD) and obesity are the worldwide public health problem. Obesity is an already well-established risk factor for CKD. The objective of this study is to evaluate the relationship between high BMI and increased risk for nephropathy by clinical data. Methods : Study group were 26 patients who had $BMI{\geq}25\;kg/m^2$ and control group were 49 patients with BMI<$25\;kg/m^2$. Both groups received renal biopsy in Kyung Hee Medical Center between 2003. Jan.-2007. Dec. BMI was calculated from measured weight and height when they were admitted to the hospital. We collected laboratory data such as CBC and blood chemistry. Results : Our hypothesis was that overweight and obesity are associated with incidence and progression of CKD. From kidney biopsy, we found IgAN 17, MesPGN 5, HSPN 2, Intestitial nephritis 1, IgMN 1 (total 26) in the study group whereas IgAN 22, MesPGN 17, HSPN 3, MGN 3, benign hematuria 2, MPGN 1, Intestitial nephritis 1, (total 49) were found in the control group. There was no significant difference between the two groups. Overweight patients demonstrated significantly higher platelet, TG, ALT, and uric acid level compared to control group. Conclusion : We identified a significant relationship between overweight and development of CKD. These results suggest that overweight children have an increased risk for CKD than those who are not obese. So, we should pay attention to children with overweight who have CKD and earlier weight management is crucial to prevent aggravation of CKD.

목 적 : 비만은 이제 전 세계적인 보건 문제 중의 하나로서 고혈압과 당뇨를 통해 만성 신장 질환 그리고 말기 신부전을 매개한다는 것은 이미 잘 알려진 사실이다. 본 연구에서는 현미경적 혈뇨 또는 단백뇨를 보여 본원에 내원하여 신생검을 시행한 초기 만성신질환 환아 중 체질량 지수 25 이상 되는 과체중군에서 신장 질환의 위험도를 증가시키고 신기능 악화인자로 작용할 수 있는 임상인자들에 대해 정상 체중군의 신질환 환아들과 비교 분석하였다. 방 법 : 2003년 1월부터 2007년 12월까지 지난 5년간 경희대학교 소아청소년과에 지속적인 혈뇨 또는 단백뇨 동반을 주소로 신생검을 시행한 4-18세의 소아 및 청소년 가운데 체질량 지수가 25 이상인 과체중군 26명(남:여=19:7)과 정상 체중의 대조군 49명(남:여=35:14), 총 75명(남:여=54:21)을 대상으로 신체 계측하고, 24시간 요 검사 및 일반 혈액학, 생화학 검사를 측정하였다. 결 론 : 본 연구에서 신질환의 진행과 악화, 심혈관계 합병증, 지방간의 진행과 관계있는 인자들이 과체중군의 환아들에게서 만성 신질환 초기에도 유의있게 높은 수치를 보여주었다. 따라서 과체중을 동반한 만성 신질환 환아들의 경우 비만에 대한 주의 깊은 관찰과 신질환의 악화를 막기 위한 조기 진단과 치료 및 예방에 힘쓰는 것이 필요할 것으로 사료된다.

Keywords

References

  1. Park YS, Lee DH, Choi JM, Kang YJ, Kim CH. Trend of obesity in school age children in Seoul over the past 23 years. Korean J Pediatr 2004:47:247-57.
  2. Park MJ. Epidemiology of the metabolic syndrome among Korean children and adolescents. Korean J Pediatr 2008;51:564-8. https://doi.org/10.3345/kjp.2008.51.6.564
  3. Lake JK, Power C, Cole TJ. Child to adult body mass index in 1958 British birth cohort: associations with parenteral obesity. Arch Dis Child 1997;77:367-81.
  4. Sinaiko AR, Donahue RP, Jacobs DR Jr, Prineas RJ. Relation of weight and rate of increase in weight during childhood and adolescence to body size, blood pressure, fasting insulin, and lipid in young adults. The Mineapolis children's blood pressure study. Circulation 1999;99:1471-6. https://doi.org/10.1161/01.CIR.99.11.1471
  5. Hus CY, Bates DW, Kuperman GJ, Curhan GC. Diabetes, hemoglobin A1c, cholesterol, and the risk of moderate chronic renal insufficiency in an ambulatory population. Am J Kidney Dis 2000;36:272-81. https://doi.org/10.1053/ajkd.2000.8971
  6. Muntner P, Coresh J, Smith JC, Eckfeldt J, Klag MJ. Plasma lipid and risk of developing renal dysfunction: The Atherosclerosis Risk in Communities Study. Kidney Int 2000;58:293-301. https://doi.org/10.1046/j.1523-1755.2000.00165.x
  7. Go AS, Chertow GM, Fan D. Chronic kidney disease and risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004;351:1296-305. https://doi.org/10.1056/NEJMoa041031
  8. Anavekar NS, McMurray JJ, Velazquez EJ. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med 2004;351:1285-95. https://doi.org/10.1056/NEJMoa041365
  9. Fox CS, Larson MG, Leip EP, Culleton B, Wilson PW, Levy D. Predictors of new-onset kidney disease in a community-based population JAMA 2004;291:844-50. https://doi.org/10.1001/jama.291.7.844
  10. Schaeffner ES, Kurth T, de Jong PE, Glynn RJ, Buring JE, Gaziano JM. Alcohol consumption and the risk of renal dysfunction in apparently healthy men. Arch Intern Med 2005;165:1048-53. https://doi.org/10.1001/archinte.165.9.1048
  11. Longenecker JC, Coresh J, Pwe NR. Traditional cardiovascular disease risk factors in dialysis patients with compared the population: The CHOICE Study. J AM Soc Mephrol 2002;13:1918-27. https://doi.org/10.1097/01.ASN.0000019641.41496.1E
  12. Kambham N, Markowitz GS, Valeri AM, Lin J, D'Agati VD. Obesity-related glomerulopathy: an emerging epidemic. Kidney Int 2001;59:1498-509. https://doi.org/10.1046/j.1523-1755.2001.0590041498.x
  13. Marchesini G, Brizi M, Morselli-labate AM, Bianchi G, Bugianesi E, McCullough AJ. Association of nonalcoholic fatty liver disease with insulin resistance. Am J Med 1999;107:450-5. https://doi.org/10.1016/S0002-9343(99)00271-5
  14. Vajro P, Fontanella A, Perna C, Orso G, Tedesco M, De Vincenzo A. Persistent hypertransaminasemia resolving after weight reduction in obese children. J Pediatr 1994;125:239-41. https://doi.org/10.1016/S0022-3476(94)70202-0
  15. Tazawa Y, Noguchi H, Nishiomiya F, Takada G. Serum alanine aminotransferase activity in obese children. Acta Paediatr 1997;86: 238-41. https://doi.org/10.1111/j.1651-2227.1997.tb08881.x
  16. Sedor JR, Schelling JR. Association of metabolic syndrome in nondiabetic patients with increased risk for chronic kidney disease: the fat lady sings. J Am Soc Nephrol 2005;16:1880-2. https://doi.org/10.1681/ASN.2005050513
  17. Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults. JAMA 2002;288;1723-7. https://doi.org/10.1001/jama.288.14.1723
  18. Beddhu S. The body mass index paradox and an obesity, inflammation, and atherosclerosis syndrome in chronic kidney disease. Semin Dial 2004;17:229-32. https://doi.org/10.1111/j.0894-0959.2004.17311.x
  19. Hall JE. The kidney, hypertension, and obesity. Hypertension 2003;41:625-33 https://doi.org/10.1161/01.HYP.0000052314.95497.78
  20. Kincaid-Smith P. Hypothesis: Obesity and the insulin resistance syndrome play a major role in end-stage renal failure attributed to hypertension and labelled hypertensive nephrosclerosis. J Hypertens 2004;22:1051-5. https://doi.org/10.1097/00004872-200406000-00001
  21. de Jong PE, Verhave JC, Pinto-Sietsma SJ. Obesity and target organ damage: The kidney. Int J Obes Relat Metab Disord 2002;26:Suppl 21-4. https://doi.org/10.1038/sj.ijo.0802213
  22. WuY, Liu Z, Xiang Z. Obesity-related glomerulopathy: Insights from gene expression profiles of the glomeruli derived from renal biopsy samples. Endocrinology 2006;147:44-50. https://doi.org/10.1210/en.2005-0641
  23. Aneja A, El-Atat F, McFarlane SI. Hypertension and obesity. Recent Prog Horm Res 2004;59:169-205. https://doi.org/10.1210/rp.59.1.169
  24. Ohno I, Hosoya T, Gomi H, Ichida K, Okabe H, Hikita M. Serum uric acid and renal prognosis in patients with IgA nephropathy. Nephron 2001;87:333-9. https://doi.org/10.1159/000045939
  25. Syrjanen J, Mustonen J, Pasternack A. Hypertriglyceridaemia and hyperuricemia are risk factors for progression of IgA nephropathy. Nephrol Dial Transplant 2002;15:34-42.
  26. Kang DH, Nakagawa T, Feng L, Watanabe S, Han L, Mazzali M, et al. A role for uric acid in the progression of renal disease. J Am Soc Nephrol 2002;13:2888-97. https://doi.org/10.1097/01.ASN.0000034910.58454.FD
  27. Haider DG, Leuchten N, Schaller G, Gouya G, Kolodjaschna J, Schmetterer L, et al. C-reactive protein is expressed and secreted by peripheral blood mononuclear cells. Clin Exp Immunol 2006;146:533-9. https://doi.org/10.1111/j.1365-2249.2006.03224.x
  28. Kang DH, Park SK, Lee IK, Johnson RJ. Uric acid-induced C-Reactive protein expression : implication on cell proliferation and nitric oxide production of human vascular cells. J Am Soc Nephrol 2005;16:3553-62. https://doi.org/10.1681/ASN.2005050572
  29. Watanabe S, Kang DH, Feng L, Nakagawa T, Kanellis J, Lan H, et al. Uric acid, hominoid evolution, and the pathogenesis of salt-sensitivity. Hypertension 2002;40:355-60. https://doi.org/10.1161/01.HYP.0000028589.66335.AA
  30. Feig DI, Nakagawa T, Karumanchi SA, Oliver WJ, Kang DH, Finch J, et al. Hypothesis: Uric acid, nephron number, and the pathogenesis of essential hypertension. Kidney Int 2004;66:281-7. https://doi.org/10.1111/j.1523-1755.2004.00729.x
  31. Iseki K, Oshiro S, Tozawa M, Iseki C, Ikemiya Y, Takishita S. Significance of hyperuricemia on the early detection of renal failure in a cohort of screened subjects. Hypertens Res 2001;24:691-7. https://doi.org/10.1291/hypres.24.691
  32. Iseki K, Ikemiya Y, Inoue T, Iseki C, Kinjo K, Takishita S. Significance of hyperuricemia as a risk factor for developing ESRD in a screened cohort. Am J Kidney Dis 2004;44:642-50. https://doi.org/10.1016/S0272-6386(04)00934-5
  33. Chin HJ, Na KY, Cheong HI, Kim YS, Kim SG, et al. The impact of serum uric acid level on the progression of IgA nephropathy. Korean J Nephrol 2008;27:46-54.
  34. Ejerblad E, Fored CM, Lindblad P, Fryzek J, Mc-Laughlin JK, Nyrn O. Obesity and risk for chronic renal failure. J Am Soc Nephrol 2006;17:1695-702. https://doi.org/10.1681/ASN.2005060638
  35. Hsu CY, McCulloch CE, Iribarren C, Darbinian J, Go AS. Body mass index and risk for end-stage renal disease. Ann Intern Med 2006;144:21-8. https://doi.org/10.7326/0003-4819-144-1-200601030-00006