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Currently filtering by tag: Obesity related glomerulopathy

Membranous Glomerulopathy in Obesity-Related Glomerulopathy

The patient is a 57-year-old female, with a history of morbid obesity and persistent mild proteinuria (approximately 1 gm), who now presents with nephrotic syndrome and a UPCR of 10.5 g/g. Renal function is normal with a serum creatinine of 0.5 mg/dl. The biopsy shows marked glomerulomegaly with focal areas of perihilar segmental glomerulosclerosis (Fig 1 and 2). Additionally, the capillary loops appear mildly thickened, with frequent subepithelial fuchsinophilic deposits on trichrome stain and diffuse and global holes and spikes seen on silver stain (Fig 3). Immunofluorescence shows global capillary loop granular staining for IgG, C3, kappa, and lambda (Fig...

Glomerulomegaly

This biopsy was performed on a 26 year old muscular male with history of persistent subnephrotic proteinuria (UPCR = 2.3 g/g) and preserved renal function. Serum albumin is maintained at 4.2 gm/dl with the remaining serologic workup negative. BMI is 38.2 kg/m2. Of note, the patient has a history of premature birth and has a twin brother with similar clinical presentation. The biopsy shows marked glomerular hypertrophy (Fig 1 and 2) with no evidence of segmental glomerulosclerosis, tubulointerstitial scarring, immune complex deposition or significant foot process effacement. Glomerular hypertrophy (glomerulomegaly) is a form of adaptive structural-functional response which occurs as...

Glomerulomegaly

This glomerulus is large! Glomerular enlargement, or glomerulomegaly, may be diagnosed when a glomerulus sectioned through the hilum fills greater than 50% of a 40x microscopic field. It is thought to be a morphologic marker of glomerular hyperfiltration. While not specific, glomerulomegaly is often seen in patients with obesity-related glomerulopathy, in which case there is often the additional finding of focal segmental glomerulosclerosis. More recently, Salvatore and colleagues found glomerulomegaly in association with either diffuse mesangial or nodular glomerulosclerosis in all patients with chronic renal insufficiency and proteinuria who had a prolonged history of smoking and hypertension (see reference). Salvatore...

Obesity-Related Glomerulopathy

This biopsy is from a 61 year-old, morbidly obese patient, who presents with 6 month history of persistent proteinuria (UPCR: 3.7 gm/gm).  The displayed glomerulus is enlarged and shows an area of segmental sclerosis involving the perihilar region of the glomerulus. Additionally, electron microscopy showed only mild epithelial foot process effacement, and immunofluorescence was completely negative. All these morphologic features are supportive of a secondary (adaptive) form of focal segmental glomerulosclerosis (FSGS).  FSGS is a pattern of glomerular injury which may be primary or secondary.  One form of secondary FSGS is believed to be the result of glomerular hyperfiltration which...