Obesity and
hyperlipidemia are the most prevalent independent risk factors of
chronic kidney disease (CKD), suggesting that
lipid accumulation in the renal parenchyma is detrimental to renal function. Non-
esterified fatty acids (also known as
free fatty acids, FFA) are especially harmful to the kidneys. A concerted, increased FFA uptake due to high fat diets, overexpression of
fatty acid uptake systems such as the CD36
scavenger receptor and the
fatty acid transport proteins, and a reduced β-oxidation rate underlie the intracellular
lipid accumulation in non-adipose tissues. FFAs in excess can damage podocytes, proximal tubular epithelial cells and the tubulointerstitial tissue through various mechanisms, in particular by boosting the production of
reactive oxygen species (ROS) and lipid peroxidation, promoting mitochondrial damage and tissue
inflammation, which result in glomerular and tubular lesions. Not all
lipids are bad for the kidneys:
polyunsaturated fatty acids (PUFA) such as
eicosapentaenoic acid (EPA) and
docosahexaenoic acid (DHA) seem to help lag the progression of
chronic kidney disease (CKD). Lifestyle interventions, especially dietary adjustments, and
lipid-lowering drugs can contribute to improve the clinical outcome of patients with CKD.