Obesity-related glomerulopathy:body mass index and proteinuria

Objective:Obesity is known to cause obesity-related glomerulopathy (ORG) in patients without preexisted renal injury.This study was addressed to observe the effect of weight loss in renal injury of patients with ORG,which not only gave us insights into the pathogenesis,but also improved the present management of ORG.Methodology:Sixty-three patients with biopsy-proven ORG recruited in this study.These patients were given advises on food uptake and lifestyle adjustment,and divided into three groups according to the changes of weight (BMI reduction ≥3%,3% and BMI increase ≥3%).The levels of proteinuria,serum triglyceride,serum uric acid as well as histological manifestations were observed in each group and compared.The assessments of therapeutic effect were taken at both 6th month and 24th month.Results:56 patients complete assessment at sixth month,and 27 patients succeeded in reduce body weight by(8.29±4.00)%,with a mean reduction of proteinuria by 35.3%.At 24th month,48 patients completed assessment,and 27 patients achieved weight loss by(-9.20±3.78)% and proteinuria reduction by-51.33%.However,in patients with increased body mass (≥3% increase),the level of proteinuria was increased by 102% and 28.8% at 6th month and 24th month respectively.Besides the changes of proteinuria,the patients with body weight loss had also decreased serum triglyceride[(-17.1±36.1)%,P0.01],serum uric acid[(-4.86±10.7)%],systolic blood pressure[(-7.44±8.42)%,P0.01],and diastolic blood pressure[(-9.50±9.08)%,P0.01].Multivariate regression modeling showed that only weight changes,but not the changes of triglyceride and uric acid could fully explain the changes in urine protein (P0.01).In 27 patients with significant weight loss,the amelioration of proteinuria was associated with stricter control of the body weight(P0.05),triglyceride(P0.01),and uric acid (P0.05).The histological manifestations could not explain the changes of urine protein at 24th month;however,the severity of tubular atrophy and interstitial fibrosis might predict the deterioration of renal function.Conclusion:Our data suggested that weight loss be associated with decreasing proteinuria in ORG patients.The effect of weight loss in amelioration of proteinuria was significant early as 6 months;while strict,prolonged weight loss and metabolic control would have more favorite outcome on proteinuria.