Obesity Renal Failure-cg 12.9.08

Obesity Renal Failure-cg 12.9.08 - Obesity and Renal...

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Obesity and Renal Failure David Shure December 2008
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Differential Diagnosis FSGS HTN Nephrosclerosis Multiple Myeloma QuickTime™ and a  decompressor are needed to see this picture.
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In 1990, among states participating in the Behavioral Risk Factor Surveillance System, 10 states had a prevalence of obesity less than 10% and no states had prevalence equal to or greater than 15%. By 1998, no state had prevalence less than 10%, seven states had a prevalence of obesity between 20-24%, and no state had prevalence equal to or greater than 25%. In 2007, only one state (Colorado) had a prevalence of obesity less than 20%. Thirty states had a prevalence equal to or greater than 25%; three of these states (Alabama, Mississippi and Tennessee) had a prevalence of obesity equal to or greater than 30%.
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1998 Obesity Trends* Among U.S. Adults BRFSS,   1990, 1998, 2007 (*BMI  30, or about 30 lbs. overweight for 5’4” person) 2007 1990 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
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Renal Adaptation to Obesity Structural: renal hypertrophy Functional: incr GFR, incr RBF 1974: assoc between massive obesity and nephrotic-range proteinuria 1st reported by Weisinger et al; Ann Intern Medicine
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Obesity-related glomerulopathy: An emerging epidemic D’Agati, et al. Columbia Univ., KI, 2001 1st large renal bx-based clinicopathologic study on obesity-related glomerulopathy Obesity = BMI >30 ORG-Obesity-related glomerulopathy defined as FSGS and/or glomerulomegaly Study to determine changing histologic incidence of ORG over past 15 yrs Compared cohort of ORG to controls w/idiopathic FSGS, found that there is a distinction bet these entities
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Methods All renal bx’s in renal path lab at Columbia Presbyterian from 1986 to 2000 for evidence of ORG Obesity-related Glomerulopathy def: 1. O-FSGS: FSGS w/glomerulomegaly 2. O-GM: glomerulomegaly alone BMI >30 Excluding pts with other dz causing secondary FSGS ie HIV, SCD, renal dysplasia, heroin use. Also DM nephropathy and HTN nephrosclerosis excluded. 103 cases met criteria
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These pt’s were compared to a historical control group of 50 pts with Idiopathic-FSGS
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QuickTime™ and a  decompressor are needed to see this picture. 2 24 77
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Obesity Related Glomerulomegaly QuickTime™ and a  decompressor are needed to see this picture.
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Segmental Sclerosis QuickTime™ and a  decompressor are needed to see this picture.
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Hypertrophy QuickTime™ and a  decompressor are needed to see this picture.
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Mild ‘Diabetoid Changes’ in non- diabetic obese pt QuickTime™ and a  decompressor are needed to see this picture.
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EM: Diffuse Glomerular BM Thickening QuickTime™ and a  decompressor are needed to see this picture.
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Minimal Foot Process Effacement QuickTime™ and a  decompressor are needed to see this picture.
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Hypertrophy QuickTime™ and a
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Obesity Renal Failure-cg 12.9.08 - Obesity and Renal...

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