Figure 3.

A proposed pathogenesis of obesity-related chronic kidney disease. Obesity leads to CKD through both systemic effects such as hypertension and hyperglycemia, and intrarenal effects associated with impaired lipid metabolism. Sodium retention and activation of the sympathetic nervous system (SNS) result in hypertension, whilst insulin resistance causes hyperglycemia. Energy excess associated with increased free fatty acids (FFAs) and reduced adiponectin, reduces the activity of AMP-activated protein kinase (AMPK), thereby increasing the activity of acetyl-CoA carboxylase (ACC). The resulting reduction in fatty acid oxidation and increase in fatty acid synthesis, promotes a situation of lipid toxicity and energy stress which further contributes to the development of CKD.