Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
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Obesity Related Glomerulopathy Progressed to Chronic Renal Failure

만성 신부전으로 진행된 비만 연관 사구체병증 1례

  • Ahn, Jung-Hee (Department of Pediatrics, Inje University College of Medicine, Sanggye Paik Hospital) ;
  • Yoon, Jung-Rim (Department of Pediatrics, Inje University College of Medicine, Sanggye Paik Hospital) ;
  • Moon, Kyung-Chul (Department of Pathology, Seoul National University school of Medicine) ;
  • Koo, Ja-Wook (Department of Pediatrics, Inje University College of Medicine, Sanggye Paik Hospital)
  • 안정희 (인제대학교 의과대학 상계백병원 소아청소년과) ;
  • 윤정림 (인제대학교 의과대학 상계백병원 소아청소년과) ;
  • 문경철 (서울대학교 의과대학 병리과학교실) ;
  • 구자욱 (인제대학교 의과대학 상계백병원 소아청소년과)
  • Received : 2010.03.19
  • Accepted : 2010.04.12
  • Published : 2010.04.30
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Abstract

Obesity-related glomerulopathy (ORG) is a secondary form of focal and segmental glomerulosclerosis (FSGS) manifesting as proteinuria and progressive renal dysfunction that results from maladaptive glomerular response to increasing adiposity. Reports of ORG progressing to end stage renal diseases in rare in the pediatric population. We report a 9-year-old boy with obesity (body mass index $35\;kg/m^2$) who was diagnosed with ORG presenting with proteinuria. He was diagnosed with obesity-related glomerulopathy based on the laboratory, urinary, and kidney biopsy finding. In spite of treatment with angiotensin- converting enzyme (ACE) inhibitor and/or, angiotensin-receptor blocking agent, the degree or amount of proteinuria increased and renal function declined continuously. His BMI did not decrease and eventually progressed to chronic renal failure. Consequently, obese patients should be monitored for proteinuria, which may be the first manifestation of FSGS, a lesion that may be associated with serious renal sequelae.

Obesity-related glomerulopathy (ORG)는 단백뇨를 보이는 비만아에서 신장 조직학적 소견상 사구체 비대, 국소 분절성 사구체 경화 소견이 관찰되고 기저막 비후, 국소 간질조직 증식, 중등도의 발 돌기 소실 등을 보이는 질환으로 정의된다. 특발성 국소분절 사구체경화증과 비교하여 신증후군이 적으며 콜레스테롤 상승이 적고, 병의 진행이 느리다는 점에서 차이가 있다고 알려져 있으며, 체중감소를 통해 신장 기능이 회복될 수 있다고 알려져 있다. 본 증례의 9세된 비만아는 임상증상과 신장 조직검사에서 ORG로 진단되어 치료하였으나, 지속적인 체중 증가와 단백뇨로 말기 신부전으로 진행하여 소아 ORG 환아에서는 드문 경과를 취하여 이를 보고하는 바이다.

Keywords

References

  1. Lobstein T, Baur L, Uaut R. Obesity in children and young people : a crisis in public health. Obes Rev 2004;5(Suppl 1):4-104. https://doi.org/10.1111/j.1467-789X.2004.00133.x
  2. Park YS, Lee DH, Choi JM, Kang YJ, Kim CH. Trend of obesity in school age children in Seoul over the Past 23 Years. Korean J Pediatr 2004;47:247-57.
  3. Southwest Pediatric Nephrology Study Group. Focal segmental glomerulosclerosis in children with idiopathic nephritic syndrome. Kidney Int 1985;27:442-9. https://doi.org/10.1038/ki.1985.29
  4. Weisinger JR, Kempson RL, Eldridge FL, Swenson RS. The nephrotic syndrome: a complication of massive obesity. Ann Intern Med 1974;81:440-7. https://doi.org/10.7326/0003-4819-81-4-440
  5. Cohen AH. Massive obesity and the kidney: a morphologic and statistical study. Am J Pathol 1975;81:117-30.
  6. Susan M, Valentina K, Lijun M, William O, Richards, Agnes B, et al. Obesity-related focal and segmental glomerulosclerosis: normalization of proteinuria in an adolescent after bariatric surgery. Pediatric Nephrol 2009;24:851-5. https://doi.org/10.1007/s00467-008-1024-6
  7. Adelman RD, Restaino IG, Alon US, Blowey DL. Proteinuria and focal segmental glomerulosclerosis in severely obese adolescents. J Pediatr 2001;138:481-5. https://doi.org/10.1067/mpd.2001.113006
  8. Kambham N, Markowitz GS, Valeri AM, Lin J, D'Agati VD. Obesity-related glomerulopathy: an emerging epidemic. Kidney Int 2001;59:1498-509. https://doi.org/10.1046/j.1523-1755.2001.0590041498.x
  9. Praga M, Hernandez E, Morales E, Campos AP, Valero MA, Martinez. Clinical features and long-term outcome of obesity-associated focal segmental glomerulosclerosis. Nephrol Dial Transplant 2001;16:1790-8. https://doi.org/10.1093/ndt/16.9.1790
  10. Henegar JR, Bigler SA, Henegar LK, Tyagi SC, Hall JE. Functional and structural changes in the kidney in the early stages of obesity. J Am Soc Nephrol 2001;12:1211-7.
  11. Hall JE. The kidney, hypertension and obesity. Hypertension 2003;41:625-33. https://doi.org/10.1161/01.HYP.0000052314.95497.78
  12. Praga M. Obesity:a neglected culprit in renal disease. Nephrol Dial Transplant 2002;17: 1157-9. https://doi.org/10.1093/ndt/17.7.1157
  13. Pietro C, Waichi S, Sirirat R, Marcelo H, Michael G, Yuri S, et al. Uric acid, the metabolic syndrome, and renal disease. J Am Soc Nephrol 2006;17:165-8. https://doi.org/10.1681/ASN.2006080909
  14. Engeli S, Bohnke J, Gorzelniak K, Janke J, Schling P, Bader M, et al. Weight loss and the renin-angiotensin- aldosterone system. Hypertension 2005;45:356-62. https://doi.org/10.1161/01.HYP.0000154361.47683.d3
  15. D'Agati VD, Fogo AB, Bruijn JA, Jennette JC. Pathologic classification of focal segmental glomerulosclerosis: a working proposal. Am J Kidney Dis 2004;43:368-82. https://doi.org/10.1053/j.ajkd.2003.10.024
  16. Rutkowski P, Klassen A, Sebekova K, Bahner U, Heidland A. Renal disease in obesity : the need for greater attention. J Ren Nutr 2006;16:216-23. https://doi.org/10.1053/j.jrn.2006.04.017
  17. Praga M, Hernandez E, Andres A, Leon M, Ruilope LM, Rodicio JL. Effects of bodyweight loss and captopril treatment on proteinuria associated with obesity. Nephron 1995;70:35-41. https://doi.org/10.1159/000188541
  18. Ghigo D, Aldieri E, Todde R, Costamagna C, Garbarino G, Pescarmona G, et al. Chloroquine stimulates nitric oxide synthesis in murine, porcine, and human endothelial cells. J Clin Invest 1998;102:595-605. https://doi.org/10.1172/JCI1052
  19. Nam SY, Son JY, Kim KW, Park UI, Kim JU, Park WH, et al. Effect of GH Treatment with Diet Restriction on GHBP Level in Obese Subjects. The Korean Journal of Obesity 2000;9:2
  20. Tran HA. Reversible obesity-related glomerulopathy following weight reduction. Med J Aust 2006;184:367.