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Évaluation de la fonction rénale du sujet obèse

  • Dossier Thématique / Thematic File
  • Published:
Obésité

Résumé

L’obésité est maintenant clairement associée au développement et à la majoration du risque de maladie rénale chronique (MRC). La question de savoir quels sont les outils les plus performants pour préciser ce risque se pose chez le sujet obèse. La MRC est définie par deux paramètres: le débit de filtration glomérulaire (DFG) et la protéinurie (albuminurie). Les différents moyens d’estimer le DFG seront discutés. En raison d’une perte de proportionnalité entre le gain de masse maigre et celui de masse grasse, la simple concentration plasmatique de créatinine ainsi que la formule de Cochroft ne sont plus recommandées pour estimer le DFG. Actuellement, en l’absence de formule spécifiquement élaborée et validée au cours de l’obésité, la formule du modification of diet in renal disease (MDRD) représente la méthode de choix, conformément aux recommandations K/DIGO 2010 (Kidney Disease Outcome Quality Initiative) élaborées pour le sujet de corpulence normale. Concernant la protéinurie, le recueil urinaire des 24 heures doit être abandonné en première intention au profit du calcul du ratio protéinurie/créatinurie sur un échantillon d’urine. Ce ratio s’exprime en milligramme par gramme, et sa classification en trois stades fait partie intégrante de l’évaluation de la MRC du sujet obèse.

Abstract

Obesity is clearly associated with the development and increased risk of chronic kidney disease (CKD). The question of which tools are better for clarifying this risk arises in obese patients. CKD is defined by two parameters: glomerular filtration rate (GFR) and proteinuria (albuminuria). The different ways of estimating GFR will be discussed. Due to a lack of proportionality between lean mass and fat mass gains, plasma creatinine and Cochcroft formula are no longer recommended for estimating GFR. There is no formula specifically developed and validated for obesity. Currently, the formula of Modification of Diet in Renal Disease (MDRD) is the preferred method, as recommended by K/DIGO 2010 (Kidney Disease Outcome Quality Initiative) for a human with normal weight. As far as proteinuria, is concerned 24 hours urine collection must be abandoned in favour of proteinuria/creatinuria ratio form a urine sample. This ratio is expressed in mg/g and this classification into three grades is part of the evaluation of CKD in obese patients.

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  1. Service de néphrologie, dialyse, transplantations, CHU de Limoges, F-87000, Limoges, France

    J. Allard

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  1. J. Allard
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Allard, J. Évaluation de la fonction rénale du sujet obèse. Obes 6, 7–10 (2011). https://doi.org/10.1007/s11690-011-0252-2

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  • DOI: https://doi.org/10.1007/s11690-011-0252-2

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