Liver-Kidney-Heart Axis in MASLD: Molecular and Cellular Pathways of Renal Injury Associated with Metabolic Hepatic Steatosis. A Narrative Review.

Abstract

Background: Steatotic liver disease associated with metabolic dysfunction (MASLD) has become the most common chronic liver disease worldwide. The impact of this condition is not limited to liver dysfunction; its relationship with chronic kidney disease (CKD) is significant, as it shares pathophysiological mechanisms and an increased risk of adverse cardiovascular outcomes. In this context, the coexistence of MASLD and CKD does not appear to be solely due to shared risk factors, but rather to convergent biological mechanisms that promote liver injury, as well as glomerular and tubular damage, including insulin resistance, inflammation, lipotoxicity, oxidative stress, neurohormonal activation, and fibrotic progression.

Summary: A detailed search was conducted in databases such as ScienceDirect, PubMed, Sage Journals, Nature, and SpringerLink to evaluate literature related to the pathophysiological mechanisms of renal dysfunction in patients with MASLD. This review analyzes the relationship between MASLD and CKD from a clinical perspective, with an emphasis on shared pathophysiological axes.

Key messages: MASLD and CKD represent much more than the coexistence of two prevalent diseases; they should be understood as the expression of systemic metabolic dysfunction, in which insulin resistance, chronic low-grade inflammation, lipotoxicity, oxidative stress, neurohormonal activation, and fibrotic progression converge.