Obesity, diabetes, and chronic kidney disease.

Similar to diabetes, obesity is associated with the early onset of glomerulomegaly, hemodynamic changes of a hyperfiltering kidney, and increased albuminuria, which are potentially reversible with weight loss. However, the pathologic lesions of focal segmental glomerulosclerosis in experimental models of sustained obesity, and in obese humans presenting with massive proteinuria, are different from those of classic diabetic nephropathy. In addition, several observational, cross-sectional, and longitudinal studies document obesity as an independent risk factor for the onset, aggravated course, and poor outcomes of chronic kidney disease, even after adjustment for confounding comorbidities, including diabetes and hypertension, the two major causes of chronic kidney disease.