Nephrol Dial Transplant (2001) 16: 1790-1798
© 2001 European Renal Association-European Dialysis and Transplant Association
Clinical features and long-term outcome of obesity-associated focal segmental glomerulosclerosis
Departments of 1Nephrology, and 2 Pathology and 3 Endocrinology, Hospital Universitario ‘12 de Octubre’, Madrid, Spain
Background. Several cases of obesity-associated focal segmental glomerulosclerosis (OB-FSG) have been reported but little is known about the clinico-pathological features of this entity and its long-term outcomers.
Methods. We studied 15 obese patients (BMI 35±5.2 kg/m2) with biopsy-proven FSG. They were compared with a control group of 15 non-obese patients with idiopathic FSG (I-FSG).
Results. Mean proteinuria at the time of renal biopsy was 3.1±2 g/24 h in OB-FSG; it reached the nephrotic range (
3.5 g/24 h) during follow-up in 12 patients (80%), but none of them had oedema, hypoproteinaemia, or hypoalbuminaemia. Proteinuria was more marked amongst I-FSG (6.5±4.2 g/24 h) and most of them developed oedema and biochemical nephrotic syndrome. Glomerulomegaly was observed in all renal biopsies from OB-FSG patients (mean glomerular diameter 256±24 µm in OB-FSG vs 199±26 µm in I-FSG, P<0.001). Twelve OB-FSG patients (80%) were treated with ACE inhibitors (ACEI) and proteinuria significantly decreased within the first 6 months of treatment but showed a later increase. None of the obese patients achieved a sustained weight loss. Seven (46%) patients with OB-FSG experienced a progressive renal insufficiency and five of them started intermittent dialysis. Kaplan–Meier estimated probabilities of renal survival after 5 and 10 years were 77 and 51%, respectively, in OB-FSG patients, and 52 and 30% in I-FSG (P<0.05). The risk of developing progressive renal failure among OB-FSG patients was statistically correlated with serum creatinine and creatinine clearance at presentation.
Conclusions. OB-FSG indicates a poor prognosis with almost one-half of patients developing advanced renal failure. Knowledge of the clinico-pathological features of this entity (obesity, FSG lesions with glomerulomegaly, absence of nephrotic syndrome despite nephrotic-range proteinuria) should be helpful in establishing an accurate and early diagnosis.
Keywords: ACE inhibitors; focal and segmental glomerulosclerosis; obesity; progression of renal insufficiency
Correspondence and offprint requests to: Dr Manuel Praga, Servicio de Nefrología, Hospital 12 de Octubre, Carretera de Andalucia, Km 5, 400, E-28041 Madrid, Spain.
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