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Clin. Med.","JCM"],"abstract":"<jats:p>Obesity-related chronic kidney disease (ob-CKD) is an increasingly prevalent condition whose pathogenesis extends beyond excess body mass to the metabolic dysfunction of visceral adipose tissue (VAT). This narrative review synthesizes the mechanistic, diagnostic, and therapeutic dimensions of the adiporenal axis: the bidirectional crosstalk between dysfunctional visceral fat and the kidney. From a pathophysiological perspective, VAT promotes renal injury through four converging pathways: hemodynamic overload via the renin\u2013angiotensin\u2013aldosterone system and sympathetic activation; adipokine imbalance (leptin excess\/adiponectin deficiency); chronic inflammation mediated by tumor necrosis factor-\u03b1 (TNF-\u03b1) and interleukin-6 (IL-6); and direct lipotoxicity from ectopic renal fat deposition. Because body mass index (BMI)fails to capture these pathogenic mechanisms, visceral adiposity-centered assessment (using waist circumference, the visceral adiposity index, and cross-sectional imaging) is essential for accurate risk stratification. The recently proposed ob-CKD classification (types 1\u20135) links disease stage to therapeutic strategy across the full CKD continuum. The therapeutic landscape now includes agents with combined weight-loss and nephroprotective properties: glucagon-like peptide-1 (GLP-1) receptor agonists (FLOW trial), dual glucose-dependent insulinotropic polypeptide (GIP)\/GLP-1 agonists (tirzepatide), sodium-glucose co-transporter 2 inhibitors (SGLT2i), and non-steroidal mineralocorticoid receptor antagonists (finerenone), alongside metabolic surgery for refractory cases. This review provides an integrative framework for shifting clinical practice from BMI-centric to visceral adiposity-driven approaches in the prevention and management of ob-CKD.<\/jats:p>","DOI":"10.3390\/jcm15187201","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T16:07:29Z","timestamp":1789574849000},"page":"7201","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Visceral Adiposity and Renal Health: From Pathophysiological Mechanisms to Novel Therapeutic Strategies"],"prefix":"10.3390","volume":"15","author":[{"given":"Mar\u00eda","family":"Marques Vidas","sequence":"first","affiliation":[{"name":"Department of Medicine, Universidad Aut\u00f3noma de Madrid, 28049 Madrid, Spain"},{"name":"Department of Nephrology, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigaci\u00f3n Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), 28222 Madrid, Spain"},{"name":"RICORS2040-Renal (RD24\/0004), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5730-1929","authenticated-orcid":false,"given":"Borja","family":"Quiroga","sequence":"additional","affiliation":[{"name":"RICORS2040-Renal (RD24\/0004), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Department of Nephrology, Hospital Universitario de la Princesa, Instituto de Investigaci\u00f3n Sanitaria del Hospital Universitario de La Princesa (IIS Princesa), 28006 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2114-1385","authenticated-orcid":false,"given":"Jose","family":"Portoles","sequence":"additional","affiliation":[{"name":"Department of Medicine, Universidad Aut\u00f3noma de Madrid, 28049 Madrid, Spain"},{"name":"Department of Nephrology, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de 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