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

• Published in: Pediatric nephrology (Berlin, West) West), 2009-04, Vol.24 (4), p.851-855
• Main Authors: Fowler, Susan M., Kon, Valentina, Ma, Lijun, Richards, William O., Fogo, Agnes B., Hunley, Tracy E.
• Format: Article
• Language: English
• Subjects: Brief Report; Child; Female; Gastric Bypass - methods; Glomerulosclerosis, Focal Segmental - complications; Glomerulosclerosis, Focal Segmental - pathology; Glomerulosclerosis, Focal Segmental - urine; Humans; Medicine & Public Health; Nephrology; Obesity, Morbid - complications; Obesity, Morbid - pathology; Obesity, Morbid - urine; Pediatrics; Proteinuria - surgery; Treatment Outcome; Urology
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/s00467-008-1024-6

Obesity-related glomerulopathy (ORG) is a secondary form of focal and segmental glomerulosclerosis (FSGS) occurring in severely obese patients. A significant percentage of individuals with ORG will develop renal insufficiency or end stage renal disease. We report here a 17-year-old girl with morbid obesity (body mass index 56.8 kg/m 2 ) and ORG presenting with nephrotic range proteinuria, who failed to improve following treatment with diet, exercise and angiotensin-converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB) therapy. Laparoscopic gastric bypass surgery was performed, and within 2 weeks following the surgery, the patient had lost 5.7 kg body weight and showed a remarkable decrease in protein excretion to one tenth of pre-surgery levels. More than 1 year after surgery, the patient’s urine protein and kidney function have remained normal while off renin–angiotensin system inhibition therapy. This is the first report of successful use of gastric bypass surgery for obesity-related glomerulopathy in an adolescent. We propose that gastric bypass surgery be considered for patients with ORG.