It is unclear what exactly accounts for the association between obesity and CKD; however, hemodynamic (glomerular hyperfiltration, glomerulomegaly, glomerulosclerosis, or increased podocyte injury) and metabolic (adipokine dysregulation, increased insulin resistance, abnormal lipid metabolism, or enhanced oxidative stress) alterations as well as lipid nephrotoxicity (excessive renal fat accumulation) may cause or worsen CKD in individuals affected by obesity [185]. This evidence concerns the gene INS and obesity due to melanocortin 4 receptor deficiency.