Endocrine Abstracts

Introduction: Obesity-related glomerulopathy(ORG) is a secondary form of focal segmental glomerulosclerosis (FSGS) occurring in obese patients with a body mass index(BMI) higher than 30 kg/m².ORG is typically manifested by nephrotic-range proteinuria without full nephrotic syndrome, and progressive renal insufficiency.

Case presentation: Thirty-six years old male patient (BMI 59.2 kg/m²) visited endocrinologist with complains of weight gain, hypertension, swollen lower extremities, dyspnea. Laboratory studies revealed: dyslipidemia, primary hypothyroidism and nodular goiter. Liver function- normal. Fasting glucose, postprandial glucose and A1C was normal-diabetes mellitus was excluded. In urine with dipstick proteinuria was found >3.0 g/l. The patient was sent to nephrologist. The level of Creatinine-normal, Urea- normal, 24 hour protein urine test: 18872 mg/24 h (N<150) and kidney biopsy was recommended. The patient was given low calorie diet (1600 kkal), L-Thyroxine 50 mkg., Simvastatin 20 mg. Because of Heart failure II (NYHA), arterial hypertension III (ESC) AR blockers and diuretics were advised. Despite of strict diet and high doses of diuretics he gained 6 kg in 7 days. Laboratory tests-slightly decreased albumin. Because of no effect of diuretics Albumin transfusion was performed. For 4 days he lost 9 kg. Only moderate edema of lower extremities rested, with AR blockers T/A was within normal range. After month proteinuria decreased till-2641 mg/24 h. He lost nearly 20 kg. He disappeared for 10 months, started to gain weight and whole clinical picture restored. Proteinuria was 4250 mg/24 h. Kidney biopsy was performed-secondary form of FSGS was diagnosed. Treatment strategy remain the same. We concluded that the main reason for proteinuria in this case was obesity.

Conclusion: ORG is in correlation with BMI. With the weight gain the level of proteinuria increases.In the early stage of kidney disease process can be reversible. Loosing weight is one of the most effective strategy of treatment.