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Impaired renal function in morbid obese patients with nonalcoholic fatty liver disease

2011; Wiley; Volume: 32; Issue: 2 Linguagem: Inglês

10.1111/j.1478-3231.2011.02623.x

1478-3231

Mariana Verdelho Machado, Sara Gonçalves, F. Carepa, Joào Coutinho, Adília Costa, Helena Cortez‐Pinto,

Diet, Metabolism, and Disease

Abstract Introduction and aims: Obesity is a common risk factor for nonalcoholic fatty liver disease ( NAFLD ) and chronic kidney disease ( CKD ). NAFLD and CKD have been associated in many epidemiological studies. We hypothesize that more severe liver disease, namely nonalcoholic steatohepatitis ( NASH ), is related with further renal impairment. We aimed to evaluate if changes in renal function were present in morbid obese patients with NAFLD . Methods Prospective and consecutive recruitment of morbid obese patients with biopsy proven NAFLD obtained during bariatric surgery. Renal function was evaluated with CKD ‐ E pidemiology C ollaboration estimated glomerular filtration rate ( eGFR ). Plasmatic adiponectin, leptin and active ghrelin concentrations were determined. Results One hundred and forty‐eight patients were included of whom 25% had NASH and 75% simple steatosis. NASH patients were older, with higher body mass index and had more frequently metabolic syndrome and lower eGFR (97 ± 22 vs 106 ± 16 ml/min/1.73 2 , P = 0.035). NASH conferred an odds ratio ( OR ) 3.0 (1.3–7.0) for eGFR < 90 and OR 9.7 (1.0–96.4) for eGFR < 60 ml/min/1.73 2 . eGFR < 90 ml/min/1.73 2 associated with aspartate aminotransferase [ OR 2.9 (1.1–7.6)] and γ‐glutamyl transpeptidase elevation [ OR 3.0 (1.3–7.2)], NASH [ OR 3.0 (1.3–7.0)], any lobular inflammatory activity [ OR 3.0 (1.3–7.0)] and severe fibrosis [ OR 3.4 (1.1–10.8)]. Neither eGFR nor liver histology was associated with adipokines levels. Conclusions In morbid obese patients, NASH , particularly lobular inflammation and advanced fibrosis, associates with mild decreases in eGFR , suggesting a common inflammatory link between liver and renal lesion.