Clinicopathological Features And Renal Prognosis Of Obesity-related Glomerulopathy In Adult Patients

Objective:To investigate the clinicopathological characteristics of ORG(obesity-related glomerulopathy)in Chinese adult patients and analyze renal outcome and prognostic risk factors.Methodology:227 adult patients with ORG were enrolled in this retrospective study,who were diagnosed by renal biopsy in the Research Institute of Nephrology,Nanjing University School of Medicine from January 2003 to December 2015.Their clinicopathological data,renal prognosis and related risk factors were assessed.Results:(1)A total of 227 patients were studied and included 67.8%males.Their average age in the renal biopsy was(39.9±9.9)years old,and majority of them were young.The average BMI of them was(30.5±3.0)kg/m2,and the average time of obesity was(14.4±8.2)years.The medium time of proteinuria was 8 months.(2)The hypertension,abnormal glucose metabolism,dyslipidemia,hyperuricemia were observed in 75.3%,49.8%,98.7%,49.8%,respectively.(3)The medium proteinuria was 0.9(0.6-1.6)g/24h,and no-massive proteinuria was major.Only 1 patient(0.4%)had nephrotic syndrome.In addition,9.7%and 55.9%patients separately suffered from impaired function of the kidney and renal tubule.(4)The pathological manifestations of ORG were glomerular hypertrophy,and 36.3%combined with FSGS,72.7%combined with light renal interstitial fibrosis.(5)The median of follow-up in this study was 61 months,the average of BMI at the last observation was(29.0±3.6)kg/m2.14 patients(6.2%)reached ESRD,18 patients(7.9%)had the end point,and 37 patients(16.3%)suffered diabetes.The 5-year and 10-year cumulative renal survival rates,calculated by Kaplan-Meier survival analysis,were 93.6%,89.9%.(6)Hypertriglyceridemia,hypo high density lipoprotein cholesterolemia,hyper urinary NAG enzyme,hyper urinary RBP,proteinuria,glomerulosclerosis and renal interstitial fibrosis in patients of obesity-associated FSGS with glomerulomegaly(O-FSGS)was worse than patients of obesity-associated glomerulomegaly alone(0-GM),and the prognosis was also worse by Kaplan-Meier analysis.(7)Multivariate Cox regression analysis showed that impaired function of the kidney,severe renal interstitial fibrosis and proteinuria during follow-up were the independent risk factors.Patients with severe renal interstitial fibrosis were associated with 9.102-fold higher risk than those with no renal interstitial fibrosis.Conclusion:ORG in Chinese adult patients was mainly characterized by young male patients,long-term obesity,various metabolic abnormalities,no-massive proteinuria,few impaired renal function,nearly half impaired renal tubular function.Pathological manifestations were glomerular hypertrophy combined with(or without)FSGS,but mostly combined with light renal interstitial fibrosis.Impaired function of the kidney,severe renal interstitial fibrosis and time-average proteinuria(TA-P)are the independent risk factors for renal function progression.Although the good prognosis of ORG in Chinese adult patients of our center,the minority still progresses to ESRD,requiring early diagnosis and treatment,especially in patients with O-FSGS.