Kidney disease in patients with obesity: It is not always obesity-related glomerulopathy alone.

TitleKidney disease in patients with obesity: It is not always obesity-related glomerulopathy alone.
Publication TypeJournal Article
Year of Publication2017
AuthorsSalvatore SP, Chevalier JM, Kuo SF, Audia PF, Seshan SV
JournalObes Res Clin Pract
Volume11
Issue5
Pagination597-606
Date Published2017 Sep - Oct
ISSN1871-403X
KeywordsAdult, Body Mass Index, Creatinine, Female, Humans, Hypertension, Kidney Glomerulus, Male, Obesity, Organ Size, Proteinuria, Renal Insufficiency, Renal Insufficiency, Chronic, Retrospective Studies, Risk Factors, Sleep Apnea Syndromes
Abstract

OBJECTIVE: Patients with obesity are at risk for chronic kidney disease. The aim is to characterize the spectrum of kidney disease in these patients, which may be related to obesity, termed obesity-related glomerulopathy (ORG), or may have other diseases secondary to associated or unassociated medical conditions.

METHODS: Native kidney biopsies from 2000 to 2012 were retrospectively reviewed from all patients with body mass index >30kg/m. Glomerular diameter was measured using a standard micrometer and clinicopathologic characteristics were analyzed.

RESULTS: 4% (287) of all biopsies were obtained from patients with obesity (mean: weight 122kg, BMI 40.4±7.35kg/m) for proteinuria in 93% and renal insufficiency in 53%. Frequent associated factors were abnormal glucose metabolism (31%), hypertension (60%), and obstructive sleep apnea (9%). Typical lesions of ORG were seen in 41% of cases and additional diseases in the rest. Glomerulomegaly, glomerular diameter >180μm, was present in 84% of cases (mean 224μm) vs normal size in 11% (mean 157μm), but was not increased with higher magnitude of obesity. Proteinuria was highest in patients with idiopathic FSGS (mean 8g/24h) and immune complex diseases (mean 7.4g/24h) and was mainly subnephrotic in obesity-related FSGS and tubulo-interstitial diseases. Creatinine levels were highest in tubulointerstitial diseases (mean 8.4mg/dL) and progressive diabetic nephropathy (mean 2.5mg/dL).

CONCLUSIONS: Diverse kidney pathology superimposed on ORG is present in patients with obesity with varied clinical renal disease, some of which may be amenable for therapy. Kidney biopsy will assist in delineating these lesions for appropriate management and prognosis.

DOI10.1016/j.orcp.2017.04.003
Alternate JournalObes Res Clin Pract
PubMed ID28442280
Related Faculty: 
Steven P. Salvatore, M.D. Surya V. Seshan, M.D.

Pathology & Laboratory Medicine 1300 York Avenue New York, NY 10065 Phone: (212) 746-6464
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