The Renal Pathology of Obesity: Structure-Function Correlations

Semin Nephrol. 2021 Jul;41(4):296-306. doi: 10.1016/j.semnephrol.2021.06.002.


The kidney is one of the target organs that may show health disorders as a result of obesity. Obesity-related glomerulopathy (ORG) is a kidney disease category based on a biopsy diagnosis that may occur secondary to obesity. Detailed clinicopathologic observations of ORG have provided significant knowledge regarding obesity-associated renal complications. Glomerulomegaly with focal segmental glomerulosclerosis of perihilar locations is a typical renal histopathologic finding in ORG, which has long been considered to represent a state of single-nephron glomerular hyperfiltration. This hypothesis was recently confirmed in ORG patients by estimating single-nephron glomerular filtration rate using a combined image analysis and biopsy-based stereology. Overshooting in glomerulotubular and tubuloglomerular interactions may lead to glomerular hyperfiltration/hypertension, podocyte failure, tubular protein-traffic overload, and tubulointerstitial scarring, constituting a vicious cycle of a common pathway to the further loss of functioning nephrons and the progression of kidney functional impairment.

Keywords: Obesity; glomerular hyperfiltration; kidney biopsy; proteinuria; single-nephron GFR.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Glomerular Filtration Rate
  • Glomerulosclerosis, Focal Segmental*
  • Humans
  • Kidney
  • Kidney Glomerulus
  • Obesity / complications
  • Podocytes*