Although the exact mechanism is not entirely understood (29), however, it has been suggested that excess adipose tissue may affect the incidence and progression of kidney disease through several pathways including altering renal blood circulation (30), the release of inflammatory mediators such as interleukin-6 or tumor necrosis factor-α (31, 32), and worsening of insulin resistance, which may be associated with renal damage (33). Here, TNF is linked to Insulin resistance.