proteinuria in a obese male

By MEDCASE EDITOR - MD | May 9, 2020

A 32-yr-old obese white man is referred for proteinuria evaluation. The patient’s proteinuria was first noted 6 mo ago on a routine annual check-up. He is morbidly obese, but he denies ahistory of sleep apnea. Physical examination shows a weight of 248 pounds; height, 5 ft 9 in;BP 148/92 mmHg; and no edema is present. He has 2.6 g of proteinuria daily, serum albumin is4.2 g/dl, serum cholesterol is 232 mg/dl, blood urea nitrogen (BUN) is 18 mg/dl, and creatinine is 1.2 mg/dl. Review of his renal biopsy shows ten glomeruli, of which two show focal segmental sclerosis; the other eight were markedly hyper-trophied. There is 40% effacement of foot pro-cesses on electron microscopy, but no electron-dense deposits or tubuloreticular inclusions are found.

Along with counseling about weight reduc-tion, initial appropriate treatment for thispatient would be which ONE of the follow-ing?

Explanation:

This obese white male has focal and segmental glomerulosclerosis (FSGS) on renal biopsy. The picture is classic for obesity-related glomerulopathy with sub-nephrotic range proteinuria, normal serum albumin, glomerulomegaly and only limited foot process effacement on electron microscopy. The pathogenesis of this form of secondary FSGS is felt to be related to hyperfiltration and/or glomerular capillary hypertension and not to an immunologic insult. Use of inhibitors of the rennin-angiotensin system has been shown to decrease proteinuria and slow progression of many glomerular diseases. Even in idiopathic FSGS the evidence justifying the use of immunosuppressive agents to treat patients with subnephrotic range proteinuria is sparse. This patient should not receive immunosuppressive agents. •

REFERENCES

Matalon A, Valeri A, Appel GB: Treatment of Focal Segmental Glomerulosclerosis. Semin Nephrol 20: 309-317, 2000 •

Kambham N, Markowitz GS, Valeri AM, Lin J, D’Agati VD: Obesity-related glomerulopathy: an emerging epidemic. Kidney Int 59: 1498-1509, 2001

Specialities In:

glomerular diseasesNEPHROLOGY

Case reviewed by MEDCASE EDITOR

Designation: MD

ABIM BOARD CERTIFIED
NEPHROLOGY

Submit a Comment