The pathogenesis, clinical treatment and research progress of obesity-related glomerulopathy disease

Obesity has become a worldwide epidemic, and the proportion of obese people has been increasing in the last decade. Obesity is a risk factor for many diseases. It affects multiple organs throughout the body, including kidney. Obesity-related glomerulopathy,(ORG) a type of obesity-related kidney disease, has been gradually recognized and valued. Obesity and high body mass index are one of the strongest risk factors for chronic kidney diseases(CKD). In obese individuals, kidneys undergo compensatory ultrafiltration to meet the high metabolic demands of weight gain. Increased pressure in the glomerulus will exacerbate kidney damage. It increases the risk of developing ORG and CKD. Previous studies on the pathogenesis of ORG have not been comprehensive, and the main known mechanisms include abnormal glomerular hemodynamics, activation of the renin-angiotensin-aldosterone system (RAAS), lipid metabolism disorders, adipocytokine disorders, insulin resistance, microinflammation, etc. The clinical presentation of ORG is atypical. Although most patients only present with stable or slowly progressive proteinuria clinically, up to one-third of patients develop progressive renal failure and end-stage renal disease. Therefore, early detection and early treatment can significantly improve the prognosis and quality of life of ORG patients. Treatment options currently include lifestyle interventions, medications, and bariatric surgery. Weight loss is central to treatment, and different treatments for weight loss can have unpredictable consequences. New therapies for lipid metabolism, drugs to enhance the body's sensitivity to insulin, and specific targeted therapies are all hot spots for future research and new hopes for therapeutic approaches. This review introduces the epidemiology of obesity and ORG, the pathological changes of ORG, the main pathogenesis discovered, and the current and future innovative treatment methods.