Microsoft Word - NEF225BF

D. Rodríguez-Puyol, Sección de Nefrología, Hospital Universitario de Alcalá de Henares, Campus Universitario, Carretera de Alcalá-Meco S/n, E-28880 Madrid (Spain) Dear Sir, Focal segmental glomerulosclerosis has been described associated to massive obesity [1]. Although its pathogenesis is not clear, hyperfiltration has been advocated as a plausible explanation. We describe a case in which proteinuria was clearly reduced after weight loss without any significant variation in the serum total protein or lipid value. Case Description A 39-year-old woman was admitted to our hospital because of respiratory failure. She was a morbid obese woman (150 cm, 117 kg) with a 4-year history of hypertension and noninsulindependent diabetes mellitus who showed symptoms of exertional dyspnea, diurnal hypersomnia and obstructive sleep apnea. Relevant laboratory data were: serum creatinine 1.7 mg/dl (150 μmol/l), creatinine clearance 33 ml/min (corrected for lean body weight), triglycerides 84 mg/dl (0.92 mmol/l), cholesterol 284 mg/dl (7.38 mmol/l), proteinuria 9 g/24 h and total protein 64 g/l. Polysomnography was performed and a definitive diagnosis of sleep apnea syndrome was established. The patient was began on a hypocaloric diet and on captopril 25 mg/day. She lost 13 kg and proteinuria was reduced to 7 g/day. Captopril was discontinued because of intolerance. Evolution in the next few months showed proteinuria in the nephrotic range which worsened proportionally to weight gain (fig. 1) as the patient did not follow the diet at home. Percutaneous renal biopsy under ultrasound control was performed showing focal segmental glomerulosclerosis without immune deposits. The patient was discharged on a treatment with theophylline, and calcium channel blockers for hypertension, and a hypocaloric diet. After a 20-kg weight reduction proteinuria was less than 1 g/24 h, total protein was 7.1 g/l and serum creatinine 1.7 mg/dl.