Obesity-Related Secondary FSGS — ESENeph MCQ

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ModerateGlomerulonephritisObesity-Related Secondary FSGSESENeph

A 45-year-old morbidly obese man (BMI 48) has proteinuria of 2.5 g/day and eGFR 65 mL/min/1.73m2. Kidney biopsy shows glomerulomegaly with perihilar segmental sclerosis. There are no immune deposits. What is the diagnosis?

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Correct answer: A — Obesity-related secondary FSGS (adaptive FSGS from glomerular hyperfiltration)

Glomerulomegaly with perihilar (not tip or cellular) segmental sclerosis, no immune deposits, in a morbidly obese patient is classic for obesity-related secondary FSGS. The mechanism is glomerular hyperfiltration from increased metabolic demand. Unlike primary FSGS, foot process effacement on EM is typically segmental (not diffuse). Treatment is weight loss (which can dramatically reduce proteinuria), RASi, and SGLT2i. Immunosuppression is NOT indicated for secondary FSGS – steroids would be harmful.

Reference: KDIGO 2021 – GN Guideline; Kambham et al 2001 – Obesity FSGS