Böbrek Hastalıkları ve Lipit Metabolizması

Böbrekler, sıvı-elektrolit dengesinin kontrolü, kandan metabolik atıkları uzaklaştırılması, eritrosit yapımı, kan basıncınındüzenlenmesi, kan hacmi ve pH’ının kontrol edilerek asit-baz dengesinin düzenlenmesinde rol oynar. Kronik BöbrekYetmezliği (KBY) glomerüler filtrasyon değerinde azalmanın sonucu olarak böbreğin sıvı-solüt dengesi ile metabolikendokrin işlevlerinde kronik ve ilerleyici bozulma olarak tanımlanmaktadır. KBY’de epitelyal hasar, glomerül ve parietalbazal membran hasarı, arteriol ve kapiller damar duvarı kalınlaşması ve lümen daralması, glomerüllerde, tübülüslerdeve membranlarda skleroz, glomerüler filtrasyon hızında (GFH) azalma, nefronların tahribi gibi yapısal değişikliklergörülmektedir. Kronik böbrek yetmezliğinde, böbrek işlevlerinde azalma ile birlikte plazma lipit ve lipoproteinmetabolizmasında, lipoproteinlerin hem miktar hem de kompozisyonunda ve apolipoproteinlerde (Apo) önemli değişiklikleroluşmaktadır ve anormal lipit metabolizması böbrek hastalarında yaygındır.

Renal Diseases and Lipid Metabolism

Kidneys play a role in liquid-electrolyte balance control, blood metabolic waste removal, erythrocyte production, blood pressure regulation, blood volume and pH control by controlling the acid-base balance. Chronic Renal Failure (CRF) is defined as a chronic and progressive deterioration in the metabolic-endocrine function of the kidney with fluid-solute balance as a result of a decrease in glomerular filtration value. In chronic renal failure, structural changes such as epithelial damage, glomerular and parietal basement membrane damage, arteriol and capillary vessel wall thickening and lumen narrowing, sclerosis in glomeruli, tubules and membranes, decrease in glomerular filtration rate (GFH), and nephron destruction are seen. In chronic renal failure (CRF), a reduction in renal function, plasma lipid and lipoprotein metabolism, both amount and composition of lipoproteins, and apolipoproteins, significant changes occur and abnormal lipid metabolism is common in kidney patients.

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1. Bobulescua IL. Renal lipid metabolism and lipotoxicity. Curr Opin Nephrol Hypertens 2010;19(4):393–402.

2. Mount P, Davies M, Choy S W, Cook N, Power D. Obesity-related chronic kidney disease: the role of lipid metabolism. Metabolites 2015;5:720-32.

3. Pandya V, Rao A, Chaudhary K. Lipid abnormalities in kidney disease and management strategies. World J Nephrol 2015;4(1):83-91.

4. Trevisan R, Dodesini AR, Lepore G. Lipids and renal disease. J Am Soc Nephrol 2006;17:145–7.

5. Kwan B, Kronenberg F, Beddhu S, Cheung AK. Lipoprotein metabolism and lipid management in chronic kidney disease. J Am Soc Nephrol 2007;18:1246– 61.

6. Vaziri ND. Dyslipidemia of chronic renal failure: the nature, mechanisms and potential consequences. Am J Physiol Renal Physiol 2006;290:262–72.

7. Vaziri ND. Causes of dysregulation of lipid metabolismin chronic renal failure. Semin Dial 2009;22(6):644–51.

8. Fouque D, Holt S, Guebre-Egziabher F, et al. Relationship between serum carnitine, acylcarnitines, and renal function in patients with chronic renal disease. J Ren Nutr 2006; 16:125.

9. Hoppel C. The physiological role of carnitine. In: L-Carnitine and Its Role in Medicine: From Function to Therapy, Ferrari R, DiMauro S, Sherwood G (Eds), Academic Press, London 1992; 5.

10. Schreiber BD. Debate forum: levocarnitine therapy is rational and justified in selected dialysis patients. Blood Purif 2006; 24:128.

11. Tonelli M, Wanner C. Lipid management in chronic kidney disease: synopsis of the Kidney Disease: Improving Global Outcomes 2013 clinical practice guideline. Ann Intern Med 2014;160: 182.