Obesity-Related Glomerulopathy: Epidemiology, Pathogenesis, and Current Treatments

Abstract

Obesity-related glomerulopathy (ORG) is a kidney disease characterized by glomerulomegaly with or without focal segmental glomerulosclerosis. With the increase in worldwide obesity rates, the number of ORG patients has also risen rapidly. Approximately 10% of ORG patients have been found to progress to the end stage of renal disease 6.2 years after diagnosis. The pathogenesis of ORG is complex, involving altered renal hemodynamics, activation of the renin–angiotensin–aldosterone system, insulin resistance, and abnormal lipid metabolism and adipokines. Despite the numerous strategies to lose weight as treatment for ORG, ranging from lifestyle and diet changes to bariatric surgery and medications, approved and marketed weight-loss drugs often have potential side effects and perform below expectations. Recently, new glucose-lowering drugs that also reduce body weight and improve kidney function have garnered attention. In particular, several large clinical trials have confirmed the efficacy and safety of sodium–glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists in reducing weight and preserving kidney function. This article provides a brief review of the epidemiology, pathogenesis, and treatment strategies of ORG.