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Abstract: SA-PO732

Obesity-Related Glomerulopathy in the Presence of APOL1 Risk Alleles

Session Information

Category: Glomerular Diseases

  • 1304 Glomerular Diseases: Podocyte Biology

Authors

  • Hti Lar Seng, Nang San, Jacobi Medical Center, Bronx, New York, United States
  • Valdez Imbert, Ronald, Jacobi Medical Center, Bronx, New York, United States
  • Jim, Belinda, Jacobi Medical Center, Bronx, New York, United States
Introduction

Apolipoprotein L1 (APOL1) confers protection from Trypanosoma brucei infections are enriched in sub-Saharan African populations. Nephropathic APOL1 risk alleles (G1/G2) have been associated with focal segmental glomerulosclerosis, HIV-associated nephropathy, SLE-associated collapsing glomerulopathy, and other glomerulonephritides. Here, we present a case of obesity-related glomerulopathy (ORG) in the setting of two APOL1 risk alleles.

Case Description

A 32-year-old female from Jamaica with a history of hypertension, preeclampsia, hyperlipidemia, and obesity (BMI 32 kg/m2) was referred to the nephrology clinic for the evaluation of proteinuria and lower extremity edema. An evaluation for secondary causes of HTN was unrevealing. The patient also denied a history of premature birth or low birth weight for herself, though noted frequent urinary tract infections as a child but was never further evaluated. Her family history was significant for her mother who developed hypertension in the mid-twenties, her maternal grandmother who experienced a cerebrovascular accident at the age of 40, and her maternal grandfather who died of end-stage kidney disease of unknown etiology. Physical examination revealed a blood pressure of 150/100 mmHg, clear lungs, normal cardiac and abdominal exam, but bilateral 2+ lower extremity pitting edema. Labs were significant for estimated glomerular filtration rate 65 (82-137 ml/min/1.73 m2) and urine protein creatinine ratio (uPCR) 2368 mg/g. Infectious and autoimmune workup were unremarkable. Kidney biopsy showed mild focal global glomerulosclerosis with glomerulomegaly with mild tubular atrophy and interstitial fibrosis. The findings of glomerulomegaly indicated glomerular hypertension and hyperfiltration, which may be related to obesity, hypertension, and/or reduced nephron number. We referred our patient to the weight management clinic, started her on losartan and atorvastatin. At four-month follow-up, her uPCR decreased to 1618 mg/g.

Discussion

Obesity may serve as a “second hit” to develop ORG. Moreover, APOL1 risk alleles may be associated with increased cardiovascular and metabolic derangements. Given the substantial morbidity and mortality from the combination of cardiovascular disease and CKD, knowledge of APOL1 risk allele status may help to better stratify cardiovascular and renal risks to help guide clinical care.