Obesity-related focal and segmental glomerulosclerosis: normalization of proteinuria in an adolescent after bariatric surgery

Fowler, Susan; Kon, Valentina; Ma, Lijun; Richards, William O.; Fogo, Agnes B.; Hunley, Tracy E.

doi:10.1007/s00467-008-1024-6

Cited by 65 publications

(40 citation statements)

References 28 publications

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“…Weight loss increases adiponectin levels and has demonstrated the ability to reduce obesity-related FSGS; our findings further reinforce the utility of this prescribed lifestyle change for obese patients. 40,41 The adiponectin-overexpressing POD-Tg mice lost an equivalent number of podocytes after dimerizer treatment, unlike past ATTAC models in which the adiponectin transgene reduced apoptosis in the target cells. 15 Oddly, POD-Tg had increased albuminuria (compared with POD mice) after podocyte loss and glomerular contraction.…”

Section: Discussionmentioning

confidence: 92%

Adiponectin Promotes Functional Recovery after Podocyte Ablation

Rutkowski

Wang²,

Park

et al. 2013

Journal of the American Society of Nephrology

147

119

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Low levels of the adipocyte-secreted protein adiponectin correlate with albuminuria in both mice and humans, but whether adiponectin has a causative role in modulating renal disease is unknown. Here, we first generated a mouse model that allows induction of caspase-8-mediated apoptosis specifically in podocytes upon injection of a construct-specific agent. These POD-ATTAC mice exhibited significant kidney damage, mimicking aspects of human renal disease, such as foot process effacement, mesangial expansion, and glomerulosclerosis. After the initial induction, both podocytes and filtration function recovered. Next, we crossed POD-ATTAC mice with mice lacking or overexpressing adiponectin. POD-ATTAC mice lacking adiponectin developed irreversible albuminuria and renal failure; conversely, POD-ATTAC mice overexpressing adiponectin recovered more rapidly and exhibited less interstitial fibrosis. In conclusion, these results suggest that adiponectin is a renoprotective protein after podocyte injury. Furthermore, the POD-ATTAC mouse provides a platform for further studies, allowing precise timing of podocyte injury and regeneration.

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Section: Discussionmentioning

confidence: 92%

Adiponectin Promotes Functional Recovery after Podocyte Ablation

Rutkowski

Wang²,

Park

et al. 2013

Journal of the American Society of Nephrology

147

119

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“…Conclusions from the studies of diabetic nephropathy (9) and unidentified chronic kidney diseases (10,11,16) could be different from those of histologic-proven ORG. And evidence from case reports (17,18) concerning the aggressive treatment of ORG with bariatric surgery is unpersuasive because only a small population was involved. In addition, the long-term effects of weight loss in patients with ORG are not studied.…”

mentioning

confidence: 99%

Obesity-Related Glomerulopathy

Shen

Chen

et al. 2010

Clinical Journal of the American Society of Nephrology

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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.

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“…Actually, ORG was a secondary form of focal and segmental glomerulosclerosis (FSGS) [17]. Glomerulomegaly was the most striking feature of ORG, which differentiated this case from primary FSGS [17]. Third renal biopsy specimens showed glomerulomegaly, hypercellularity, mesangial expansion, and thickened GBM, all of which were well compatible with ORG.…”

Section: Case Reportmentioning

confidence: 76%

“…Histologically, ORG was characterized by glomerular enlargement, mild hypercellularity, variable widening of mesangial regions, podocyte hypertrophy, thickening of GBMs, and at times focal segmental sclerosis [6,16]. Actually, ORG was a secondary form of focal and segmental glomerulosclerosis (FSGS) [17]. Glomerulomegaly was the most striking feature of ORG, which differentiated this case from primary FSGS [17].…”

Section: Case Reportmentioning

confidence: 84%

Proteinuria rebound in IgA nephropathy associated with obesity-related glomerulopathy

Matsukura¹,

Sakakibara

Sakamoto

et al. 2015

CEN Case Rep

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IgA nephropathy (IgAN), the most prevalent primary chronic glomerulonephritis worldwide, has three major risk factors: hypertension, proteinuria [1 g/day, and severe renal lesions. Obesity also portends a poor prognosis. A Japanese boy with IgAN showed nephrotic syndrome at presentation. Pathological features resembled those of membranoproliferative glomerulonephritis (MPGN), although IgA deposition differed from MPGN and IgAN. Combination therapy improved renal lesions, but rebound deterioration of proteinuria occurred in this patient, who had marked obesity and hypertension. Serial kidney biopsy specimens were compatible with obesityrelated glomerulopathy (ORG). Rebound proteinuria was apparently attributable to ORG rather than relapse and flaring up of IgAN.

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Obesity-related focal and segmental glomerulosclerosis: normalization of proteinuria in an adolescent after bariatric surgery

Cited by 65 publications

References 28 publications

Adiponectin Promotes Functional Recovery after Podocyte Ablation

Adiponectin Promotes Functional Recovery after Podocyte Ablation

Obesity-Related Glomerulopathy

Proteinuria rebound in IgA nephropathy associated with obesity-related glomerulopathy

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