CLINICAL FEATURES AND OBESITY IMPACT ON CHRONIC KIDNEY DISEASE PROGRESSION IN PATIENTS WITH GLOMERULAR DISEASES

Abstract BACKGROUND AND AIMS The kidney disease secondary to obesity is obesity-related glomerulopathy characterized by the following: glomerulomegalia, progressive glomerulosclerosis, proteinuria and progression of renal failure. The aims of the present study were to evaluate the clinical features and 2 years outcome in obese and non-obese patients with glomerular diseases. METHOD This study included 125 patients with renal biopsy-proven glomerular diseases: minimal change disease, FSGS, IgA nephropathy, membranous glomerulonephritis, membranoproliferative glomerulonephritis (mean age 46.93 ± 15.10 years). There were 63 obese (BMI ≥ 27 kg/m2) and 62 non-obese (BMI <27 kg/m2) patients. The serum concentration of protein, albumin, cholesterol, trygliceride, creatinine and daily proteinuria were measured at the time of kidney biopsy, 6, 12 and 24 months after the biopsy. The estimated glomerular filtration rate (eGFR) was calculated according to the equations: Cockcroft–Gault#(Cockcroft–Gault–BMI < 27 kg/m2 Cockcroft–GaultLBW-BMI ≥27kg/m2) and Chronic Kidney Disease Epidemiology Collaboration Equation (CKD–EPI). RESULTS At the time of kidney biopsy, the obese had significantly lower eGFR calculated by formulas: Cockcroft–Gault# (62.29 ± 27.53 versus 96.30 ± 38.80 mL/min) and CKD–EPI (71.52 ± 31.15 versus 86.36 ± 27.63 mL/min/1.73 m2), significantly higher daily proteinuria (6.11 ± 4.94 versus 4.47 ± 4.95 g/day), creatinine (122.14 ± 87.56 versus 93.66 ± 41.40 μmol/L), trygliceride (2.76 ± 1.39 versus 2.20 ± 1.30 mmol/L) in comparison with non-obese. There was statistically significant difference in eGFR calculated by Cockcroft-Gault# 6 months (t = 5.353, P < .01), 12 (t = 5.234, P < .01) and 24 months (t = 2.329, P < .05) after the kidney biopsy between obese and non-obese. The reduction in eGFR Cockcroft–Gault# after 24 months compared with baseline in obese was 14.7%, in non-obese 13.7% (P > 0.05). After 12 months follow-up significantly higher percentage of non-obese patients reached complete remission (59.4% versus 35.3%) compared with obese (χ2 = 4.548), but after 24 months there were no significant difference. CONCLUSION Obese patients at the time of kidney biopsy, 6, 12 and 24 months later had the significant lower eGFR compared to non-obese. After 24 months follow-up there was no significant difference in percentage of patients with complete remission between two groups, although after 12 months follow-up a significantly smaller number of obese were in complete remission.