METHODS: We analyzed 14,492 kidney biopsies in 18 hospitals from 1979 to 2018 in Korea. Obesity was defined as a body mass index value of ≥ 30 kg/m².
RESULTS: The most common disease was IgA nephropathy (IgAN) in both obese and non-obese participants (33.7% vs. 38.9%). Obesity was associated with a higher risk of focal segmental glomerulosclerosis (FSGS) and hypertensive nephropathy (HT-N) (odds ratio [OR], 1.72, 95% confidence interval [CI], 1.37-2.17; OR, 1.96, 95% CI, 1.21-3.19) and a lower risk of IgAN (OR, 0.74, 95% CI, 0.62-0.88). During the median follow up of 93.1 ± 88.7 months, obesity increased the risk of end-stage kidney disease (ESKD) in patients with IgAN (relative risk [RR], 1.49, 95% CI, 1.01-2.20) and lupus nephritis (LN) (RR, 3.43, 95% CI, 1.36-8.67). Of 947 obese individuals, ORG was detected in 298 (31.5%), and 230 participants had other kidney diseases, most commonly, IgAN (40.9%) followed by diabetic nephropathy (15.2%). Participants with ORG, when combined with other renal diseases, showed higher risks for developing ESKD compared to those with ORG alone (RR, 2.48, 95% CI, 1.09-5.64).
CONCLUSIONS: Obesity is associated with an increased risk of FSGS and HT-N, and also increase the ESKD risk in IgAN and LN patients. ORG in obese participants may have favorable renal outcomes if it occurs alone without any other renal disease.
方法:我们分析了1979年至2018年韩国18家医院的14,492例肾脏活检。肥胖定义为体重指数值≥30kg/m²。
结果:肥胖和非肥胖参与者中最常见的疾病是IgA肾病(IgAN)(33.7%vs.38.9%)。肥胖与局部节段肾小球硬化(FSGS)和高血压肾病(HT-N)的高风险相关(比值比[OR],1.72,95%置信区间[CI],1.37-2.17;或,1.96,95%CI,1.21-3.19)和较低的IgAN风险(OR,0.74,95%CI,0.62-0.88)。中位随访93.1±88.7个月,肥胖增加了IgAN患者终末期肾病(ESKD)的风险(相对风险[RR],1.49,95%CI,1.01-2.20)和狼疮性肾炎(LN)(RR,3.43,95%CI,1.36-8.67)。在947名肥胖个体中,在298(31.5%)中检测到ORG,230名参与者患有其他肾脏疾病,最常见的是,IgAN(40.9%)其次是糖尿病肾病(15.2%)。ORG参与者,当与其他肾脏疾病合并时,与单独使用ORG的患者相比,出现ESKD的风险更高(RR,2.48,95%CI,1.09-5.64)。
结论:肥胖与FSGS和HT-N的风险增加有关,并增加IgAN和LN患者的ESKD风险。如果肥胖参与者的ORG单独发生而没有任何其他肾脏疾病,则可能具有良好的肾脏结局。