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Cited by 222Chronic Kidney Disease and DiabetesBlood Pressure and Hypertension StudiesRenin-Angiotensin System Studies

Mechanisms of Hypertension and Kidney Disease in Obesity

HALL, JOHN E., BRANDS, MICHAEL W., HENEGAR, JEFFREY R.·1999·Annals of the New York Academy of Sciences
DOI 10.1111/j.1749-6632.1999.tb07788.x
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Abstract

ABSTRACT: Abnormal kidney function is an important cause as well as a consequence of obesity. Excess renal sodium reabsorption, probably in the loop of Henle, and a hypertensive shift of pressure natriuresis play a major role in initiating increased blood pressure associated with weight gain. The mechanisms responsible for increased sodium reabsorption and altered pressure natriuresis in obesity include activation of the renin‐angiotension and sympathetic nervous systems, and physical compression of the kidneys due to accumulation of intrarenal fat and extracellular matrix. Sympathetic activation may be mediated, in part, by elevated circulating leptin and interactions with neuropeptides in the hypothalamus. Renal remodeling and extracellular matrix proliferation likely involve complex interactions between intrarenal physical forces, neurohumoral factors, and local growth factors and cytokines. Although glomerular hyperfiltration and increased arterial pressure help to compensate for increased renal tubular reabsorption in the early phases of obesity, these changes also increase glomerular capillary wall stress which, along with activation of neurohumoral systems and increased lipids and glucose intolerance, cause glomerular cell proliferation, matrix accumulation, and eventually glomerulosclerosis and loss of nephron function in the early phases of obesity. This creates a slowly developing vicious cycle that requires additional increases in arterial pressure to maintain sodium balance and therefore makes effective antihypertensive therapy more difficult. Because obesity is the main cause of Type 2 diabetes and an important cause of human essential hypertension, it seems likely that obesity is also one of the most important risk factors for end‐stage renal disease.

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  • Increases in total tissue pressure and interstitial fluid hydrostatic pressure to −19 mmHg have been observed in obese dogs.

    “Increases in total tissue pressure and interstitial fluid hydrostatic pressure to −19 mmHg have been observed in obese dogs56.”

    From Obesity, kidney dysfunction and hypertension: mechanistic links (2019) · cites this paper as [56]

  • Renal interstitial fluid hydrostatic pressure was elevated to 19 mmHg in obese dogs compared to only 9-10 mmHg in lean dogs.

    “Supporting the concept that visceral obesity compresses the kidneys is the observation that renal interstitial fluid hydrostatic pressure was elevated to 19 mmHg in obese dogs compared to only 9–10 mmHg in lean dogs34.”

    From Obesity-Induced Hypertension: Interaction of Neurohumoral and Renal Mechanisms (2015) · cites this paper as [34]

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Authors
HALL, J. E., BRANDS, M. W., & HENEGAR, J. R.
Affiliations
University of Mississippi Medical Center (US)
Corresponding author
HALL, JOHN E.
ORCID
Venue
Annals of the New York Academy of Sciences
Publisher
Wiley
Published
1999-11
Volume
892
Issue
1
Pages
91-107
ISSN
  • 0077-8923 (ISSN-L)
  • 1749-6632
DOI
10.1111/j.1749-6632.1999.tb07788.x
OpenAlex
W2159168356
Cited by
222
References
59
Citations by year
2026: 2 · 2025: 5 · 2024: 8 · 2023: 7 · 2022: 4 · 2021: 1 · 2020: 4 · 2019: 7 · 2017: 8 · 2016: 7 · 2015: 8 · 2014: 9 · 2013: 15 · 2012: 9
FWCI
2.48
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 2289 d)
Locations
  • Annals of the New York Academy of Sciences (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Heart, Lung, and Blood Institute (HL‐51971, P01HL051971)
Topics
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
Keywords
obesity, hypertension, kidney disease, sodium reabsorption, loop of Henle, pressure natriuresis, renin-angiotensin system, sympathetic nervous system, leptin, extracellular matrix, renal remodeling, glomerular hyperfiltration, glomerulosclerosis, end-stage renal disease, type 2 diabetes, essential hypertension
MeSH terms
Cardiac Output, Glomerular Filtration Rate, Humans, Hyperinsulinism, Hypertension, Kidney Diseases, Kidney Failure, Chronic, Natriuresis, Obesity, Regional Blood Flow, Renin-Angiotensin System, Weight Gain, Body Mass Index, Glucose Intolerance

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