High prevalence of renal microvascular disease in patients with metabolic syndrome
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The aim of this cross-sectional study was to explore kidney pathological findings in patients with metabolic syndrome. To this end, clinical information for 146 patients undergoing elective nephrectomy for renal cell carcinoma between January 2005 and March 2007 at two US hospitals was retrospectively screened. In total, 12 patients with metabolic syndrome were identified, and 12 age- and sex-matched patients without any component of the metabolic syndrome were used as controls. The histological characteristics of nephrectomy carcinoma-free specimens were evaluated independently by two pathologists blinded to the clinical diagnosis using Banff criteria. Histological examination revealed that compared to controls, patients with metabolic syndrome exhibited a significantly greater prevalence of tubular atrophy, interstitial fibrosis, and arterial sclerosis, in addition to greater global and segmental glomerulosclerosis. The prevalence of the combined end-point of tubular atrophy greater than 5%, interstitial fibrosis greater than 5%, and the presence of arterial sclerosis was higher in patients with metabolic syndrome than in controls. Moreover, after 1 year, estimated glomerular filtration rate from the remaining kidney was significantly lower in patients with metabolic syndrome versus controls. These results suggest that in patients with metabolic syndrome, there is a high prevalence of microvascular disease associated with a steeper decrease in kidney function over time, suggesting limited renal functional reserve.
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