Which Patients with Obesity Are at Risk for Renal Disease?

Abstract

Obesity-related glomerulopathy (ORG) is an increasingly recognized cause of end-stage kidney disease. The most common clinical presentation is a slowly increasing nonnephrotic proteinuria that is followed by a progressive decline of kidney function. Key histological findings are glomerulomegaly and lesions of focal and segmental glomerulosclerosis. A central pathogenic mechanism is the increased sodium reabsorption by proximal tubules that typically accompanies obesity. This causes a decrease in the offer of sodium to the macula densa in the distal nephron, which results in a vasodilation of afferent glomerular arterioles and glomerular hyperfiltration. From a clinical point of view, it is essential to differentiate focal segmental glomerulosclerosis secondary to obesity from primary glomerular processes, which requires a careful differential diagnosis. Diet-induced weight loss, bariatric surgery, and renin-angiotensin blockers are the fundamental therapeutic measures in ORG. The recently developed sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 agonist represent a significant advance in renal protection and will probably improve clinical kidney outcomes in ORG.

Comment on “Which Patients with Obesity Are at Risk for Renal Disease?”

“…We read with interest the review of Dr. Sandino et al [1]. We agree with the authors that the association between the obesity, nonnephrotic proteinuria, and endstage renal disease shows an increasing trend, but it remains unclear why only some subjects with obesity develop CKD.…”

Diagnostic value of renal biopsy in anti-phospholipase A2 receptor antibody-positive patients with proteinuria in China

“…Obesity has currently become an epidemic. ORG is strongly associated with CKD 33 , and patients with obesity are likely to develop drug-induced diabetes when treated with steroids or immunosuppressants, which are the mainstay for MN therapy. Therefore, a renal biopsy could be highly considered for SAb + patients with obesity.…”

Novel Insights in the Physiopathology and Management of Obesity-Related Kidney Disease

“…It is important to identify which patients with obesity may develop CKD, since not all of them are at equal risk [ 19 ]. It has been widely described that there are different phenotypes of obesity [ 20 ]: metabolically healthy obesity phenotype is characterized by high insulin sensitivity, low prevalence of hypertension and a favorable fasting glucose, lipid, and inflammation profile.…”