Effect of childhood obesity and obesity-related cardiovascular risk factors on glomerular and tubular protein excretion

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Abstract
There is increasing evidence that obesity may damage the kidney in otherwise healthy individuals. Our study investigated the effect of childhood obesity on urinary albumin and beta-2-microglobulin excretion, and the association of these with obesity-related cardiovascular risk factors. Random morning spot urine samples were collected from clinically healthy obese ( n =86; median age 12.9 years, range 8.9–17.2 years; median weight 80.6 kg, range 46.1–136.8 kg; median body mass index 30.4 kg/m2, range 24.5–43.2 kg/m2) and normal weight children ( n =79; median age 13.5 years, range 10.7–14.9 years; median weight 51.0 kg, range 27.3–72.5 kg; median body mass index 18.2 kg/m2, range 13.2–23.9 kg/m2). The obese children were examined for the presence of common obesity-related cardiovascular risk factors including hyperinsulinaemia, impaired glucose tolerance (IGT), dyslipidaemia, hypercholesterolaemia, and hypertension. Obese children had a significantly higher urinary albumin/creatinine ratio (U-ACR) (median 11.7 mg/g, interquartile range 12.9 mg/g versus median 9.0 mg/g, interquartile range 5.1 mg/g; P =0.003) and urinary beta-2-microglobulin/creatinine ratio (U-BMCR) (median 63.9 µg/g, interquartile range 34.7 µg/g versus median 34.6 µg/g, interquartile range 44.1 µg/g; P P r =0.23, P r =0.37, P P Conclusion:According to our results, clinically healthy obese children have a higher degree of albuminuria and beta-2-microglobulinuria than normal weight children, indicating early renal glomerular and tubular dysfunction as a consequence of childhood obesity. The urinary albumin/creatinine ratio in the obese children was associated with certain metabolic derangements linked to obesity, and also with the clustering of features of the metabolic syndrome.