World Kidney Day(WKD) is celebrated every year on 2 nd Thursday of March with the aim to raise awareness about burden of chronic kidney disease and encourage general public and government to take steps for prevention and early detection of the disease. This year WKD is focusing to promote education on harmful consequences of obesity and it's association with kidney disease.

Obesity is a growing worldwide epidemic. It is one of the strongest risk factor for new onset of CKD, kidney stone disease and various cancers involving different parts of body. Obesity is defined as having BMI of more than or equal to 30 kilogram per meter square. Worldwide about 600 million people suffer from obesity and in India about 30 million people suffer from obesity. India is no 1 in under weight population and 3 rd most obese country in the world after U.S.A and China. 22 % of Indian children suffer from obesity. Morbid obesity affects 5% of total population and is growing at an alarming rate. Obesity kills more people than malnutrition. But the good news is that obesity is largely preventable

CAUSES OF OBESITY :

Multiple factors may interact and contribute to obesity. It may be due to sedentary life style, unhealthy eating habits, lack of exercise, psychological factors such as stress or depression, genetic & family history etc..

It is the central or visceral obesity in the trunk and abdominal cavity that is associated with higher risk of several diseases (Android obesity) rather than diffuse accumulation of fat (Gynaecoid obesity). Waist hip ratio (WHR) >90cm in male and >80 cm in female has better correlation than BMI with central obesity.

HOW OBESITY AFFECTS BODY ?

White adipose tissue (WAT) is not merely an energy storage organ but is responsible for metabolic disturbances. Increased obesity initates cascades of event . It promotes pro-inflammatory environment in the body by up regulation of adipokinase and down regulation of anti inflammatory cytokine adiponectin. Its secretes many biologically active substances such as leptins, free fatty acids, TNF alpha, IL6, IL18 chemokines. and angiotensin-2. Metabolic disturbances are responsible for insulin resistance, hyperglycemia, dyslipidemia, hypertension and atherosclerosis. Hyperinsulinemia and various cytokines are key factors for complications related to obesity. There is cross talk between adipose tissue and various organs resulting various obesty related complications

HOW OBESITY DIRECTLY CAUSES CKD :

Obesity is associated with increased load on the kidney causing hyperfilteration and increased glomerular permeability . Increased renal plasma flow leads to glomerular hypertension and proteinuria. Renal hemodynamic abnormality, endothelial and podocyte dysfunction is also contributed by hyperinsulinemia and increased level of angiotensin II. Renal biopsy in obese patients reveal glomerulomegaly and focal segmental sclerosis through haemodynamic and nonhemodynamic effects . Chronic kidney diseases progress two to seven times faster in obese patient as compared to normal body weight people.

Light microscopy showing characterstic features of Focal Segmental glomerulosclerosis,halinosis and adhesions

HOW OBESITY INDIRECTLY CAUSES CKD :- Obesity is the root cause of Diabetes and Hypertension which are responsible for >70% of CKD.

Other obesity related disorder mainly are , heart disease, obstructive sleep apnea, NASH, gall stones, osteoarthritis and various cancers of body.

MANAGEMENT OF OBESITY :

Weight reduction Measures : -
The mainstay of treatment is life style modification, increased physical activity, dietary restriction and behavioural therapy.

1. Daily regular aerobic exercises of more than 30 minutes per day is of great value. Regular exercise such as brisk walking, running, swimming, dancing etc. Talk to your health care professional before you begin new exercise programme

2. Diet should be of low dense calories, and deficit of 600 to 800 calories per day, having low sodium, high potassium and low in fat specially trans-fats. Fresh fruits, vegetables, salads and healthy food should be taken. Avoid alcohol and fast food and frozen food.

3. Behavioural therapy consist of counselling to relieve stress and drepression and counselling for eating habits. Behaviour modification technique such as 1) Keep a food diary everything you eat. 2) Donot shop when you are hungry. 3) Take a different route if you pass by tempteing fast food place

4. Pharmacotherapy : Handful of drugs most of them anorexiants excepts orlistat which inhibits fat absorption causing steatorrhea. They must be taken under the supervision of physician as all of them are potentially toxic.

5. Bariatric sugery should be offered to those having BMI > 40 kg/metre square or patient having BMI of 35-40 kg/metre square with obesity related complications. It is gastric bypass surgery. It reduces the overall mortality by about 40%. It is performed laproscopically by sleeve gastrectomy reducing capacity of stomach to 200 cc or by performing Roux en Y gastric bypass.

Eight golden rules to prevent kidney disease

1. Keep fit and active.
2. Eat healthy food & control body weight
3. Control blood sugar level
4. Control blood pressure
5. Drink 3-4 litre of water daily
6. Avoid smoking.
7. Avoid drugs from over the counter.
8. Regular screening for kidney function.