2026-01-20
Obesity: when the kidneys become overwhelmed
Endocrinology and Metabolism
By Ana Espino | Published on January 16, 2026 | 3 min read
Obesity is a chronic condition that is rapidly increasing worldwide and is associated with numerous metabolic, cardiovascular and renal complications. Among these complications, obesity-related glomerulopathy (ORG) is a still poorly understood condition characterized by moderate proteinuria, glomerular hypertrophy and progression to chronic kidney disease, even in the absence of diabetes or severe hypertension. However, this condition remains under-diagnosed, mainly due to the lack of specific criteria, the low use of renal biopsy, and the difficulty in distinguishing it from other glomerular nephropathies.
Therefore, there are two challenges: to improve the early detection of OGR and to identify the most effective therapeutic approaches to slow its progression. In this context, this study was initiated in order to synthesize current knowledge on the pathophysiology, diagnosis and management of ORG to better structuring prevention and intervention strategies in obese patients at renal risk.
How does obesity damage the glomeruli?
In this study, the underlying pathophysiological mechanisms of ORG have been investigated, as well as the diagnostic criteria and the therapeutic interventions evaluated.
In terms of pathophysiology, ORG is associated with persistent glomerular hyperfiltration, a glomerular hypertrophy, and progressive podocytes damage. These alterations are facilitated by several factors: insulin resistance, activation of the renin-angiotensin-aldosterone system (RAAS), chronic low-grade inflammation, and mechanical modifications related to intraglomerular hypertension.
From a diagnostic perspective, ORG is characterized by often moderate, non-selective proteinuria without nephrotic syndrome and glomerular hypertrophy visible on histology, often without major podocytes damage in the early stages. The natural course can lead to focal segmental glomerulosclerosis (FSGS). Diagnosis remains difficult without renal biopsy, which is rarely performed in obese patients.
In terms of therapy, results indicate that weight loss, particularly after bariatric surgery, can lead to a significant reduction in proteinuria and slow the decline in renal function. In addition, recent metabolic treatments, such as SGLT2 inhibitors and GLP-1 agonists, show renal protective potential in obese patients, although specific data on ORG are still limited. Blood pressure control using RAAS inhibitors (ACE inhibitors/ARBs) remains essential to slow progression.
ORG: early detection, rapid action
Obesity is now recognized as a direct risk factor for glomerular damage, through a specific entity called obesity-related glomerulopathy. This often silent condition progresses gradually to renal failure, even in the absence of classic comorbidities. The main challenge lies in early detection, distinguishing it from other glomerular nephropathies and the lack of specific recommendations tailored to this condition. The aim of this review was to better characterize the mechanisms, diagnostic criteria and therapeutic approaches of ORG in order to guide the management of obese patients at renal risk.
About the author – Ana Espino
As
a scientific writer, Ana is passionate about bridging the gap between
research and real-world impact. With expertise in immunology, virology,
oncology, and clinical studies, she makes complex science clear and
accessible. Her mission: to accelerate knowledge sharing and empower
evidence-based decisions through impactful communication.
PhD in Immunology, specialized in Virology
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