Obesity-related glomerulopathy: body mass index and proteinuria

Abstract

Background and objectives: Obesity-related glomerulopathy (ORG) is an increasing cause of end-stage renal disease, but evidence concerning the effects of treatments is rather limited. This study was aimed at exploring the renoprotective effects of weight loss on patients with ORG.

Design, setting, participants, & measurements: A total of 63 patients with renal biopsy-proven ORG had food and exercise intervention in the physician-supervised weight loss program and were divided into three groups on the basis of the percentage of weight change from baseline to follow-up: significant weight loss (>3% reduction in body mass index [BMI]), stable weight, or significant weight gain (>3% increase). Metabolic parameters and renal lesions were evaluated regularly for 2 years.

Results: After 6 months, 27 patients lost weight by 8.29 +/- 4.00%, with a mean decrease in proteinuria of 35.3%, whereas 24 months later, 27 patients achieved a 9.20 +/- 3.78% reduction in BMI and a 51.33% reduction in urine protein secretion. The levels of serum triglyceride, serum uric acid, and BP were also decreased. Contrarily, in patients with increased BMI, urine protein was increased by 28.78%. Correlation analysis showed proteinuria was associated with BMI, serum triglyceride, and uric acid, and multivariate regression analysis indicated the changes in BMI were the only predictor of proteinuria (P < 0.01).

Conclusions: Weight loss intervention benefited remission of proteinuria in patients with ORG, whose function could not be replaced by conventional pharmacotherapy.

Figure 1.

Relationship between changes in body weight and outcome of proteinuria at the (a) 6th month (short term) and (b) 24th month (long term).

Figure 2.

Results from univariate regression analysis, relating change in proteinuria (dependent variable) at the 24th month. Ch, serum cholesterol; Glu, fasting blood glucose; SBP, systolic BP; DBP, diastolic BP; ΔACEI/ARB, new use of angiotensin-converting enzyme inhibitors and/or angiotensin II receptor blockers; Δrhein, new use of rhein; ΔLLD, new use of lipid-lowering drugs.

Figure 3.

Relationships between the extent of reduction in BMI, TG, UA, and outcome of proteinuria in 27 patients with decreased BMI after a 2-year follow-up. Solid spots represent remission in proteinuria (complete remission and improvement in proteinuria; n = 15); hollow spots represent nonremission in proteinuria (stable and deteriorated proteinuria; n = 12).