Immunologic and endocrine functions of adipose tissue: implications for kidney disease
Abstract
Excess adiposity can induce adverse sequelae in multiple cell types and organ systems. The transition from the lean to the obese state is characterized by fundamental cellular changes at the level of the adipocyte. These changes affect the local microenvironment within the respective adipose tissue but can also affect nonadipose systems. Adipocytes within fat pads respond to chronic nutrient excess through hyperplasia or hypertrophy, which can differentially affect interorgan crosstalk between various adipose depots and other organs. This crosstalk is dependent on the unique ability of the adipocyte to coordinate metabolic adjustments throughout the body and to integrate responses to maintain metabolic homeostasis. These actions occur through the release of free fatty acids and metabolites during times of energy need - a process that is altered in the obese state. In addition, adipocytes release a wide array of signalling molecules, such as sphingolipids, as well as inflammatory and hormonal factors (adipokines) that are critical for interorgan crosstalk. The interactions of adipose tissue with the kidney - referred to as the adipo-renal axis - are important for normal kidney function as well as the response of the kidney to injury. Here, we discuss the mechanistic basis of this interorgan crosstalk, which clearly has great therapeutic potential given the increasing rates of chronic kidney disease secondary to obesity and type 2 diabetes mellitus.
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Adipocytes secrete many bioactive substances that influence metabolic and cardiovascular functions, including blood pressure.
“Adipocytes are much more than just energy-storage depots — they secrete many bioactive substances that influence metabolic and cardiovascular functions, including BP110.”
From Obesity, kidney dysfunction and hypertension: mechanistic links (2019) · cites this paper as [110]
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Adipogenesis and metabolic health
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Self-citationObesity, kidney dysfunction and hypertension: mechanistic links
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“These adipocytes release FFAs and metabolites, including inflammatory factors, such as interleukin-6 (IL-6), and tumor necrosis factor (TNFα), and hormonal factors, such as leptin, angiotensin II, which mediate kidney injury.(56) In other tissues, like the liver, kidney, and heart, PPAR-γ is also expressed at a low le…”
BackgroundAdiponectin, Leptin and Cardiovascular Disorders
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“Although excessive weight gain and increased adiposity initially cause modest increases in BP, obesity-induced metabolic and inflammatory disorders interact with HT to promote gradual injury to blood vessels and various organs, including the heart and kidneys.(6,120,156,157) The impact of obesity on chronic kidney dis…”
BackgroundPro-resolving lipid mediators: regulators of inflammation, metabolism and kidney function
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“NAFLD (also known as MASLD) which comprises steatosis, NASH, fibrosis and cirrhosis, affects approximately 55% of individuals”
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Immune Dysfunction in Uremia 2020
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“Interactions of the adipose tissue with the kidney (adipo-renal axis) are important for normal kidney function and response to injury [208].”
BackgroundECM formation and degradation during fibrosis, repair, and regeneration
Mayorca‐Guiliani, A. E., Leeming, D. J., Henriksen, K., Mortensen, J. H., Nielsen, S. H., Anstee, Q. M., Sanyal, A. J., Karsdal, M. A., & Schuppan, D. (2025) · npj Metabolic Health and Disease · doi:10.1038/s44324-025-00063-4 · Cited by 172 · see citing works
“Fibrotic progression in WAT is correlated with higher risks of infection 276 , cancer (including breast, uterus, ovaries, colon, stomach, esophagus, rectum, liver, pancreas, kidney, meninges, and blood), metabolic, kidney, cardiovascular, and psychiatric disease.”
InfluentialAssociation of metabolic syndrome and chronic kidney disease
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Obesity: A neuroimmunometabolic perspective
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Angiotensin-(1-7), Adipokines and Inflammation.
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Suppressing adipocyte inflammation promotes insulin resistance in mice
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“In fat depots, approximately 20e40% of all cells consist of adipocytes, while the rest are composed of preadipocytes, endothelial cells, and many immune cells taking part in both the innate and adaptive immune systems [14].”
BackgroundSelf-citationAdipocyte mesenchymal transition contributes to mammary tumor progression
Zhu, Q., Zhu, Y., Hepler, C., Zhang, Q., Park, J., Gliniak, C. M., Henry, G. H., Crewe, C., Bu, D., Zhang, Z., et al. (2022) · Cell Reports · doi:10.1016/j.celrep.2022.111362 · Cited by 99 · see citing works
“These are cells with enhanced catabolism, in which “lipid-storing” white adipocytes are replaced by “lipid-burning” beige adipocytes (Kajimura et al., 2015; Singh et al., 2016; Zhu and Scherer, 2018).”
Self-citationOrgan System Crosstalk in Cardiometabolic Disease in the Age of Multimorbidity
Oishi, Y., & Manabe, I. (2020) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2020.00064 · Cited by 96 · see citing works
Obesity-related kidney disease: Beyond hypertension and insulin-resistance
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“While diabetes and hypertension are significant contributors to obesity-related CKD, recent decades of research have shown that adipocytes are potent endocrine cells, releasing adipokines which exert direct pathologic effects on the kidney (17).”
InfluentialChen, X., Han, Y., Gao, P., Yang, M., Xiao, L., Xiong, X., Zhao, H., Tang, C., Chen, G., Zhu, X., et al. (2019) · Kidney International · doi:10.1016/j.kint.2018.10.038 · Cited by 90 · see citing works
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Mechanisms and treatment of obesity-related hypertension—Part 1: Mechanisms
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“Moreover, perirenal/sinus fat produces adipocytokines such as leptin, resistin, IL-1 β , IL-6, TNF-α , etc., which may also contribute to obesity-related hypertension by stimulating inflammatory processes and by activating the SNS and the RAAS [65 –68 ].”
BackgroundCzaja-Stolc, S., Potrykus, M., Stankiewicz, M., Kaska, Ł., & Małgorzewicz, S. (2022) · Nutrients · doi:10.3390/nu14071457 · Cited by 85 · see citing works
“Leptin increases the expression of the transforming growth factor-β 1 (TGF-β1) gene and other fibrotic factors, such as collagen IV and fibronectin, which stimulate the proliferation of mesangial cells in the kidneys [55].”
BackgroundMitochondrial regulation and white adipose tissue homeostasis
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Self-citationPartial leptin deficiency confers resistance to diet-induced obesity in mice
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“Based on these observations, we propose that limiting the rise in leptin levels under obesogenic conditions exerts beneficial effects on energy homeostasis [45].”
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Adipocyte dedifferentiation in health and diseases
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“Leptin, for example, is known for its role on satiety sensation by the central nervous system (CNS), which in turn suppresses food intake and promotes lipolysis [27].”
BackgroundKidney Damage Caused by Obesity and Its Feasible Treatment Drugs
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“Large amounts of lipid accumulation lead to lipotoxicity, where short-chain fatty acids rely on a passive diffusion of CD36, and fatty acids transport proteins to enter the cell [93], while long-chain fatty acids can only enter the cell through CD36 [94].”
BackgroundUnderlying Mechanisms of Renal Lipotoxicity in Obesity
Escasany, E., Izquierdo‐Lahuerta, A., & Medina‐Gómez, G. (2019) · The Nephron journals/Nephron journals · doi:10.1159/000494694 · Cited by 73 · see citing works
Role of the adaptive immune system in diabetic kidney disease
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Metabolic syndrome and systemic lupus erythematosus: the connection
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From Obesity to Chronic Kidney Disease: How Can Adipose Tissue Affect Renal Function?
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An Overview of Chronic Kidney Disease Pathophysiology: The Impact of Gut Dysbiosis and Oral Disease
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“Pharmacological interventions that modulate adipose tissue function have demonstrated kidney-protective effects in models of CKD and diabetic nephropathy [123].”
BackgroundBlood Flow Restriction Training Blunts Chronic Kidney Disease Progression in Humans
Corrêa, H. D. L., Neves, R. V. P., Deus, L. A., Souza, M. K., Haro, A. S., Costa, F., Silva, V. L., Santos, C. A. R., Moraes, M. R., Simões, H. G., et al. (2020) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000002465 · Cited by 51 · see citing works
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Elevated CCL2 causes Leydig cell malfunction in metabolic syndrome
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Obesity and risk of end-stage renal disease in patients with chronic kidney disease: a cohort study
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Lubojemska, A., Stefana, M. I., Sorge, S., Bailey, A. P., Lampe, L., Yoshimura, A., Burrell, A., Collinson, L., & Gould, A. P. (2021) · PLoS Biology · doi:10.1371/journal.pbio.3001230 · Cited by 46 · see citing works
“For example, the adipo-renal axis is deregulated such that an altered blend of adipokines and other adipose-derived factors produces renal inflammation, fibrosis, and oxidative stress, leading to defective glomerular filtration and proteinuria [7,8].”
BackgroundCheng, Z., Xiong, X., Zhou, Y., Wu, F., Shao, Q., Dong, R., Liu, Q., Li, L., & Chen, G. (2021) · Biomedicine & Pharmacotherapy · doi:10.1016/j.biopha.2021.112491 · Cited by 47 · see citing works
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“This, in turn, resulted in increased migration of endothelial cells and increased monolayer permeability, which ultimately resulted in ED [9,87].”
BackgroundInfluentialFOXO1 regulates the formation of bovine fat by targeting CD36 and STEAP4
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Adipose Tissue Metabolic Function and Dysfunction: Impact of Burn Injury
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“Several recent reviews have detailed the role of adipose tissue in preventing lipotoxicity and metabolic dysfunction in healthy versus obese individuals (Boura-Halfon and Zick, 2009; Virtue and Vidal-Puig, 2010; Nielsen et al., 2014; Fasshauer and Bluher, 2015; Zhu and Scherer, 2018; Ghaben and Scherer, 2019).”
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Prebiotic prevents impaired kidney and renal Oat3 functions in obese rats
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Interorgan communication networks in the kidney–lung axis
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From fat to filter: the effect of adipose tissue-derived signals on kidney function
Ahmed, N., Dalmasso, C., Turner, M. B., Arthur, G., Cincinelli, C., & Loria, A. S. (2025) · Nature Reviews Nephrology · doi:10.1038/s41581-025-00950-5 · Cited by 37 · see citing works
“The dysregulated adi-pokine production in WAT also accelerates cellular senescence, which further exacerbates inflammation and the production of adipokines and adipocytokines, worsening endothelial dysfunction, podocyte injury and renal fibrosis 16,21,23,60 (Figs.”
Mehanna, E. T., Barakat, B. M., El-Sayed, M. H., & Tawfik, M. K. (2018) · European Journal of Pharmacology · doi:10.1016/j.ejphar.2018.05.028 · Cited by 35 · see citing works
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Mechanism of Acupuncture in Treating Obesity: Advances and Prospects
Wang, M., Zhai, M.-X., Wang, Y.-T., Dai, Q.-F., Liu, L., Zhao, L., Xia, Q., Shen, L., & Li, B. (2024) · The American Journal of Chinese Medicine · doi:10.1142/s0192415x24500010 · Cited by 31 · see citing works
Childhood Obesity: Insight into Kidney Involvement
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“It also has inflammatory and anti-apoptotic properties, probably through the activation of AMP-activated protein kinase signaling [91,96].”
Novel Insights in the Physiopathology and Management of Obesity-Related Kidney Disease
Sandino, J., Martín-Taboada, M., Medina‐Gómez, G., Vila‐Bedmar, R., & Morales, E. (2022) · Nutrients · doi:10.3390/nu14193937 · Cited by 29 · see citing works
“Different studies have drawn attention to the pathophysiological functions of several adipokines, and their contribution to CKD has been extensively reviewed elsewhere [8,11,30].”
BackgroundWang, H., Xu, P., Li, J., Liu, X., Wu, X., Fang, X., Xie, B., Huang, X., Zhou, Z., Kayoumu, A., et al. (2018) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.00180.2018 · Cited by 27 · see citing works
“Adipose tissue is an endocrine organ rather than a mere passive fat depot (39).”
BackgroundYang, F., Duan, M., Zheng, F., Yu, L., Wang, Y., Wang, G., Lin, J., Han, S., Gan, D., Meng, Z., et al. (2021) · Cancer Letters · doi:10.1016/j.canlet.2021.09.024 · Cited by 27 · see citing works
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“Although the liver is an important organ responsible for lipid metabolism, adipose tissue also plays significant roles in body homeostasis by storing lipids as an energy source and releasing adipokine to regulate metabolic functions [57].”
BackgroundNon-Coding RNAs and Adipogenesis
Ru, W., Zhang, S., Liu, J., Liu, W., Huang, B., & Chen, H. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24129978 · Cited by 26 · see citing works
“Signaling proteins secreted by white adipose tissue are known as adipokines, including adiponectin, leptin, tumor necrosis factor (TNF), interleukin 6 (IL-6), adipocyte fatty acid-binding protein (AP2) and so on, which are involved in coordinating the body’s metabolism [5].”
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Hydrogen Sulfide, Adipose Tissue and Diabetes Mellitus
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Obesity–cancer axis crosstalk: Molecular insights and therapeutic approaches
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“Therapies that target glucagon-like peptide-1 (GLP-1) may prove effective for the treatment of obesity and T2DM.”
InfluentialChan, C. W., & Lin, B. (2023) · Nutrients · doi:10.3390/nu15163616 · Cited by 23 · see citing works
“Further, our result showed that renal TGF-β1 positively correlated with renal leptin, which is consistent with the mechanism that STAT3 signaling activation by leptin receptor increases renal TGF-β1 production of kidney resident cells during the development of fibrosis [18].”
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“Adiponectin levels decrease with increasing body weight, and decreased levels of adiponectin are associated with increased proteinuria and GFR since adiponectin has insulin-sensitizing, anti-inflammatory, and anti-apoptotic properties [109,110].”
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Adipose Tissue Inflammation: Linking Physiological Stressors to Disease Susceptibility
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Obesity, Weight Gain, and Fluid Overload in Peritoneal Dialysis
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PAQR4 regulates adipocyte function and systemic metabolic health by mediating ceramide levels
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Potential role of adipose tissue and its hormones in burns and critically III patients
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“However, it has been proposed that the chronic elevation of blood leptin may be associated with altered signalling of both insulin and leptin [64, 65], dysregulation of lipid metabolism [66], blood pressure, and kidney diseases [67, 68].”
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“26 WAT is an important endocrine and regulatory organ, 27,28 its impairment reflects the homeostatic imbalance of substances important for energy storage and metabolism, such as leptin, insulin, and ghrelin.”
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“promotes renal inflammation, oxidative stress, and fibrosis, ultimately impairing renal function.(171,174) However, once CKD occurs, adipose tissue may play a protective role by serving as a “buffer” to sequester uremic toxins and neutralize the harmful effects of some cytokines.”
BackgroundMechanisms of interorgan crosstalk in health and disease
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“Consequently, a state of healthy obesity characterized by normative adipose immunological and secretory functions may be conducive to the preservation of renal function (49 ), However, the specific mechanism needs further experimental and clinical research.”
BackgroundObesity Facts and Their Influence on Renal Function Across the Life Span
Koch, V. H. K. (2021) · Frontiers in Medicine · doi:10.3389/fmed.2021.704409 · Cited by 15 · see citing works
Role of miR-379 in high-fat diet-induced kidney injury and dysfunction
Abdollahi, M., Kato, M. V., Lanting, L. L., Wang, M., Tunduguru, R., & Natarajan, R. D. (2022) · American Journal of Physiology-Renal Physiology · doi:10.1152/ajprenal.00213.2022 · Cited by 14 · see citing works
Chronic kidney disease combined with metabolic syndrome is a non-negligible risk factor
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“Because PRAT is anatomically in direct contact with the kidneys and adrenal glands, its presence can lead to various pathological abnormalities when body size increases (including expansion of perirenal adipose tissue) due to obesity or other problems (e.g., diabetes, DKD) [16].”
BackgroundPropionate Induces Energy Expenditure via Browning in Mesenteric Adipose Tissue
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Transcription-Based Multidimensional Regulation of Fatty Acid Metabolism by HIF1α in Renal Tubules
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“Ceramide was demonstrated to regulate various cellular responses like inflammation and apoptosis and was linked closely with renal dysfunction (Zhu and Scherer, 2017; Huwiler and Pfeilschifter, 2018).”
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“In addition, it has been described that low levels of leptin are associated with protein energy wasting in people with CKD, hemodialysis and with a worse prognosis [47–49], even though a correlation with the amount of fat mass is maintained [50].”
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Body composition, adipokines, FGF23-Klotho and bone in kidney transplantation: Is there a link?
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Visceral Adipose Tissue: A New Target Organ in Virus-Induced Type 1 Diabetes
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“WAT is the most abundant fat accounting for 5% to 50% of human body weight (107).”
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“The interaction between adipose and renal tissue, the so called adipo-renal axis, is critical for kidney health [4].”
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“Although the regulated activation of macrophages plays an essential role in host defenses against bacterial infections, excessive activation of macrophages causes several inflammation-related diseases, such as asthma and endotoxin-induced multiple-organ injury [13,14].”
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“…and progression of MetS-related CKD. Adipose tissue dysfunction and aberrant secretion and release of adipokines and inflammatory cytokines in MetS may induce systemic chronic low-grade inflammation, oxidative stress, and endothelial dysfunction, resulting in renal injury and dysfunction (12, 36).”
BackgroundAdipolin protects against renal injury via PPARα-dependent reduction of inflammasome activation
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Inflammatory mediators in the adipo-renal axis: leptin, adiponectin, and soluble ICAM-1
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Role of Inflammatory Cytokines in Obese and Nonobese Diabetic Children
Abdelhamid, E. R., Kamhawy, A. H., Ahmed, H. H., Shady, M. M. A., Eladawy, R., Megawer, A. S., & Amrousy, Y. M. (2020) · Open Access Macedonian Journal of Medical Sciences · doi:10.3889/oamjms.2020.4982 · Cited by 7 · see citing works
“which explained this as obesity is associated with hyperleptinemia, which contributes to a decline in eGFR and pathological processes [43].”
Background
- Authors
- Zhu, Q., & Scherer, P. E.
- Affiliations
- The University of Texas Southwestern Medical Center (US)
- Corresponding author
- Scherer, Philipp E.
- Venue
- Nature Reviews Nephrology
- Published
- 2017-12-04
- Volume
- 14
- Issue
- 2
- Pages
- 105-120
- ISSN
- 1745-8323 (ISSN-L)
- 1759-5061
- 1759-507X
- OpenAlex
- W2775650155
- Cited by
- 200
- References
- 222
- Citations by year
- 2026: 14 · 2025: 26 · 2024: 30 · 2023: 32 · 2022: 27 · 2021: 24 · 2020: 22 · 2019: 16 · 2018: 9
- FWCI
- 1.70
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Nature Reviews Nephrology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- Topics
- Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
- Health Sciences › Medicine › Physiology › Adipose Tissue and Metabolism
- Keywords
- adipose tissue, adipokines, chronic kidney disease, obesity, type 2 diabetes, organ crosstalk, free fatty acids, sphingolipids, kidney injury, metabolic homeostasis
- MeSH terms
- Adipose Tissue, Angiotensin II, Angiotensinogen, Diabetes Mellitus, Type 2, Humans, Inflammation, Kidney Diseases, Macrophages, Obesity, Signal Transduction, Leptin, Adiponectin, Adipokines, Receptors, Adiponectin, AMP-Activated Protein Kinases, Ceramidases
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