De novo focal segmental glomerulosclerosis and kidney hypertrophy associated with progressive obesity after kidney transplantation

摘要

Background: Obesity is an important problem associated with worsening cardiovasculardisease and the progression of proteinuria in kidney transplant recipients. We describe acase of de novo focal segmental glomerulosclerosis (FSGS) associated with progressiveobesity after kidney transplantation (KTx).Case Presentation: A 41-year-old male patient underwent an allograft kidney biopsybecause of nephrotic range proteinuria. The donor was his father who was aged 70years at transplantation. In addition, there was a substantial difference in body weight(BW) between the recipient and donor. At 56 months after kidney transplantation, thepatient’s BW increased from 83.1 kg (BMI, 29.3 kg/m2) before kidney transplantation to93.9 kg (BMI, 33.1 kg/m2). An allograft biopsy showed glomerular hypertrophy and focalsegmental sclerotic lesions with partial epithelial cell hyperplasia. The histologic diagnosiswas FSGS, not otherwise specified (NOS) variant. A comparison between the kidneyvolume before and after kidney transplantation, evaluated using volumetric computedtomography, revealed prominent kidney hypertrophy (1.77 times).Conclusions: Our case demonstrated that de novo FSGS after kidney transplantation isinduced by progressive obesity, as manifested by glomerular hypertrophy as well as kidneyhypertrophy. This is a hyperdynamic state contributed to the pathogenesis of de novoFSGS. Our report is important to understand the pathogenesis of FSGS.