Department of Pathology and Cell Biology, Division of Renal Pathology, Columbia University Medical Center, New York, New York, USA.
Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York, USA.
Kidney Int. 2019 Mar;95(3):647-654. doi: 10.1016/j.kint.2018.11.026. Epub 2019 Jan 31.
Morbid obesity, defined as body mass index (BMI) ≥40 kg/m, affects approximately 8% of United States adults and is a recognized risk factor for chronic kidney disease (CKD). We present the first focused biopsy-based study exploring the range of kidney diseases in this population. Among 3263 native kidney biopsies interpreted at Columbia University in 2017, we identified 248 biopsies from morbidly obese patients. In this cohort with median age of 53.5 years, 56% were female and median BMI was 44.0 kg/m. Diabetes and hypertension were present in 47% and 81% of patients, respectively. Median estimated glomerular filtration rate (eGFR) was 30 ml/min/1.73 m, and most patients had nephrotic range proteinuria. Obesity related glomerulopathy (ORG), defined as focal segmental glomerulosclerosis with glomerulomegaly or glomerulomegaly alone, was detected in 73 patients, including 29 with ORG alone and 44 with ORG plus another kidney disease. In contrast, 167 patients had other kidney diseases alone, without ORG, most commonly (in descending order) diabetic nephropathy, acute tubular necrosis, hypertensive nephrosclerosis, IgA nephropathy, membranous nephropathy, and lupus nephritis. In 49% of patients, kidney biopsy yielded a diagnosis predicted to change patient management. The strongest predictor of non-ORG lesions was eGFR <30 ml/min per 1.73 m, and presentation with nephrotic syndrome or acute kidney injury (with or without background CKD) was more common in non-ORG than ORG. The findings reveal an unexpectedly broad spectrum of kidney pathology beyond metabolic syndrome-associated disorders and highlight the importance of kidney biopsy to guide management and prognosis in the morbidly obese population.
病态肥胖定义为体质指数（BMI）≥40kg/m²，影响约 8%的美国成年人，是慢性肾脏病（CKD）的公认危险因素。我们报告了第一项以肥胖症患者为研究对象的重点活检研究，旨在探索该人群的肾脏疾病范围。在 2017 年哥伦比亚大学解读的 3263 例原发性肾脏活检中，我们确定了 248 例来自病态肥胖症患者的活检。在该队列中，患者的中位年龄为 53.5 岁，56%为女性，BMI 中位数为 44.0kg/m²。分别有 47%和 81%的患者患有糖尿病和高血压。中位估算肾小球滤过率（eGFR）为 30ml/min/1.73m²，大多数患者有肾病范围蛋白尿。肥胖相关性肾小球病（ORG）定义为局灶节段性肾小球硬化伴肾小球肿大或仅肾小球肿大，在 73 例患者中检测到，其中 29 例为 ORG 单纯型，44 例为 ORG 合并另一种肾脏疾病。相比之下，167 例患者单独患有其他肾脏疾病，没有 ORG，最常见的（按降序排列）为糖尿病肾病、急性肾小管坏死、高血压性肾硬化、IgA 肾病、膜性肾病和狼疮性肾炎。在 49%的患者中，肾脏活检结果改变了患者的治疗方案。eGFR<30ml/min/1.73m²是出现非-ORG 病变的最强预测因素，而非-ORG 比 ORG 更常见于肾病综合征或急性肾损伤（伴有或不伴有背景 CKD）的表现。这些发现揭示了除代谢综合征相关疾病以外，病态肥胖症患者的肾脏病理存在广泛的谱，突出了肾脏活检对指导肥胖症患者管理和预后的重要性。
