Clinical features and long‐term outcome of obesity‐associated focal segmental glomerulosclerosis

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Abstract
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, PPConclusions. 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.