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The Renal Pathology of Obesity: Structure-Function Correlations

Nobuo Tsuboi1, Yusuke Okabayashi1

  • 1Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.

Seminars in Nephrology
|October 30, 2021
PubMed

Insights

Obesity can harm kidneys, leading to obesity-related glomerulopathy (ORG). This kidney disease involves glomerular hyperfiltration, a state confirmed by new research, contributing to kidney function decline.

Area of Science:

  • Nephrology
  • Pathology
  • Obesity Medicine

Background:

  • Obesity is a significant risk factor for kidney disease.
  • Obesity-related glomerulopathy (ORG) is a biopsy-diagnosed kidney condition linked to obesity.
  • Clinicopathologic studies offer insights into renal complications of obesity.

Purpose of the Study:

  • To confirm the hypothesis of single-nephron glomerular hyperfiltration in ORG patients.
  • To elucidate the mechanisms driving kidney damage in obesity-related glomerulopathy.

Main Methods:

  • Utilized a combination of image analysis and biopsy-based stereology.
  • Estimated single-nephron glomerular filtration rate in ORG patients.
  • Detailed clinicopathologic observations.

Main Results:

  • Confirmed single-nephron glomerular hyperfiltration as a key feature in ORG.
  • Identified glomerulomegaly and focal segmental glomerulosclerosis in perihilar locations as typical histopathologic findings.
  • Demonstrated overshooting in glomerulotubular and tubuloglomerular interactions.

Conclusions:

  • Single-nephron glomerular hyperfiltration is a confirmed mechanism in ORG.
  • This hyperfiltration contributes to podocyte damage, tubular overload, and tubulointerstitial scarring.
  • A vicious cycle of nephron loss and kidney function impairment is established in ORG.
Keywords:
Obesityglomerular hyperfiltrationkidney biopsyproteinuriasingle-nephron GFR

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