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Leptin and end-stage renal disease

Authors
Lynda Szczech, MD, MSCE
Jula K Inrig, MD, MHSc
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD

INTRODUCTION

Leptin is the 16,000 dalton protein product of the obesity gene (ob), which is mainly produced by adipocytes [1]. In animal models, it is a potent anorectic and regulates energy expenditure [2-4] and may be similarly involved in body weight maintenance in humans.

Leptin is released into the bloodstream, where it binds to leptin-binding proteins and is transported into the cerebrospinal fluid by receptors in the choroid plexus via a saturable transport mechanism [5]. It exerts its major effect on the hypothalamus, where a Janus kinase signal transducer and activator of transcription (Jak/STAT) signal cascade is activated. This decreases production of neuropeptide Y (NPY), an extremely potent appetite stimulant, thereby resulting in suppressed appetite, increased energy expenditure, and weight loss [6]. In addition, leptin suppresses alpha-melanocyte-stimulating hormone, a compound that also blocks feelings of hunger.

Investigators have therefore postulated that leptin may be related to the anorexia and protein energy wasting frequently observed in patients with end-stage renal disease (ESRD). A review of leptin in patients with chronic kidney disease (CKD) is presented here. Detailed discussions relating to the physiology of leptin and the pathogenesis of obesity are presented separately. (See "Physiology of leptin" and "Pathogenesis of obesity".)

PHYSIOLOGIC EFFECTS

Obesity gene (Ob)/ob mice have genetic traits that result in marked obesity, hyperphagia, glucose intolerance, insulin resistance, low energy expenditure, and sterility. When these mice are exposed to circulating factors from normal mice, they reduce food intake and experience weight loss. Via a positional cloning approach, this factor was isolated and subsequently named leptin, from the Greek word leptos, meaning "thin" [1]. When recombinant leptin is exogenously administered to ob/ob mice, food intake is reduced and physical activity is enhanced, leading to weight loss [2-4].

A distinct obese strain of mice that is phenotypically identical to the ob/ob mouse is the db/db mouse. These mice have a mutation in the leptin receptor, with hyperleptinemia due to receptor resistance.

          

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Literature review current through: Nov 2016. | This topic last updated: Wed Aug 19 00:00:00 GMT+00:00 2015.
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