NDT Advance Access published online on July 13, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp329
Early histological changes in the kidney of people with morbid obesity
1 Department of Internal Medicine-Nephrology, University Hospital, Patras, Greece 2 Sheffield Kidney Institute, Sheffield Teaching Hospitals, Northern General Campus, Sheffield, UK 3 Mario Negri Institute for Pharmacological Research, Bergamo, Italy 4 Department of Surgery, University Hospital, Patras, Greece
Correspondence and offprint requests to: Dimitrios S. Goumenos; E-mail: dgoumenos{at}med.upatras.gr
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Abstract |
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Background. Morbid obesity represents a major health problem with increasing incidence worldwide. The clinical manifestation of renal involvement in obesity is proteinuria, and the histological feature is glomerulomegaly with or without focal and segmental glomerulosclerosis (FSGS). In this study, we have investigated the very early histological changes in kidneys of people with morbid obesity and no proteinuria.
Patients and methods. Eighteen patients with body mass index (BMI) >50 kg/m2 who underwent a variant of biliopancreatic diversion with Roux-en-Y reconstruction (BPD-RYGBP) and consented to undergo a renal biopsy during the surgical procedure were included in the study. The estimation of early histological changes was performed on light (n = 18) and electron microscopy (n = 13).
Results. The mean glomerular cross-sectional area was 30 943 ± 10 984 µm2 that is higher than that observed in non-obese individuals. In 21% of the examined glomeruli, the glomerular planar surface area (GPSA) was >40 000 µm2. Thickening of the glomerular basement membrane (GBM) and scattered paramesangial deposits were identified in 9 of 13 patients (70%) whose renal tissue was examined by electron microscopy. A reduction in the slit pore frequency was observed in obese patients due to extensive foot process effacement. Significant positive correlations between mean GPSA and body weight (r = 0.462, P = 0.05), and between GBM thickness and HbA1c, serum total cholesterol and triglyceride levels (r = 0.60, P = 0.05; r = 0.789, P = 0.004; r = 0.70, P = 0.016, respectively), were observed.
Conclusions. Glomerulomegaly as well as histological lesions resembling those of early diabetic nephropathy are observed in kidney biopsies of patients with morbid obesity even before the appearance of microalbuminuria. The potential regression of these changes after weight loss needs to be clarified.
Keywords: glomerular disease; glomerular volume; obesity; podocytes
Received for publication: 13. 3.09
Accepted in revised form: 15. 6.09