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Obesity and overweight, which are common in patients with DM2, are a factors that favor the development/progression of CKD through both direct and indirect effects.69 Although the precise mechanisms the association between obesity and CKD are not totally defined it has been proposed that hypertension, glomerular hyperfiltration, hyperglycemia, lipid toxicity, inflammation or the role of adipose tissue and its adipokines are involved.70 Weight reduction by bariatric surgery, pharmacological treatment or dietary measures are associated with a nephroprotective effect,7173 so that weight reduction is a fundamental objective in the nephroprotection of patients with DKD

Microscopically, physiologic pigmentation is characterized by the presence of increased amounts of melanin within the basal cell layer

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Common side effects include nausea, vomiting, diarrhea, and constipation, which generally diminish over time