Obesity related glomerulopathy

Current issue of Kidney International features the largest series of renal biopsy findings in patients with morbid obsesity.This study includes analysis of 248 biopsies in patients with morbid obesity and brings forth some interesting facts. Morbid obesity is defined as BMI > 40kg/m2& is a recognized risk factor for chronic kidney disease (CKD). Among 3263 native kidney biopsies interpreted at Columbia University in 2017, authors encountered 248 biopsies from morbidly obese patients.  Diabetes and hypertension were present in 47% and 81% of patients, respectively. Median estimated glomerular filtration rate (eGFR) was 30 ml/min/1.73 m2, and most patients had nephrotic range proteinuria. Obesity related glomerulopathy (ORG), defined as focal segmental glomerulosclerosis with glomerulomegaly or glomerulomegaly alone, was detected in 73 patients, including 29 with ORG alone and 44 with ORG plus another kidney disease. In contrast, 167 patients had other kidney diseases alone, without ORG, most commonly (in descending order) diabetic nephropathy, acute tubular necrosis, hypertensive nephrosclerosis, IgA nephropathy, membranous nephropathy, and lupus nephritis. In 49% of patients, kidney biopsy yielded a diagnosis predicted to change patient management. The strongest predictor of non-ORG lesions was eGFR <30 ml/min per 1.73 m2, and presentation with nephrotic syndrome or acute kidney injury (with or without background CKD) was more common in non-ORG than ORG. The findings reveal an unexpectedly broad spectrum of kidney pathology beyond metabolic syndrome-associated disorders and highlight the importance of kidney biopsy to guide management and prognosis in the morbidly obese population.
Few other studies on this topic can be read by clicking on links below:
Obesity-related glomerulopathy: pathogenesis, pathologic, clinical characteristics and treatment
Obesity-related glomerulopathy: clinical and pathologic characteristics and pathogenesis.
The Renal Pathology of Obesity.