Nephron 1990:56:225-226 © 1990 S. Karger AG. Basel 0028-2766/90/0562-0225S2.75/Q Weight Reduction in Massive Obesity Associated with Focal Segmental Glomerulosclerosis: Another Evidence for Hyperfiltration? S. Lamas*, A. Sauz3, A. Ruizb, J. Alvárez\ F. Mejia*. D. Rodriguez-Puyol* Departments of “ Medicine and '’Pathology, Hospital Universitario de Alcalá de Henares, Universidad de Alcalá de Henares. Madrid, Spain Dear Sir, Focal segmental glomerulosclerosis has been de scribed associated to massive obesity [I], Although its pathogenesis is not clear, hyperfiltration has been advo cated as a plausible explanation. We describe a case in which proteinuria was clearly reduced after weight loss without any significant variation in the serum total pro tein or lipid value. Case Description A 39-year-old woman was admitted to our hospital because of respiratory failure. She was a morbid obese woman (150 cm, 117 kg) with a 4-year history of hypertension and noninsulin-dependent diabetes mellitus who showed symptoms of exertional dyspnea, diurnal hypersomnia and obstructive sleep apnea. Relevant labora tory data were: serum creatinine 1.7 mg/dl (150 pmol/l), creatinine clearance 33 ml/min (corrected for lean body weight), triglycerides 84 mg/dl (0.92 mmol/1), cholesterol 284 mg/dl (7.38 mmol/1), proteinuria 9 g/24 h and total protein 64 g/1. Polysomnography was performed and a definitive diagnosis of sleep apnea syndrome was established. The patient was began on a hypocaloric diet and on captopril 25 mg/day. She lost 13 kg and proteinuria was reduced to 7 g/day. Captopril was discontinued because of intolerance. Evolution in the next few months showed proteinuria in the nephrotic range which worsened proportionally to weight gain (fig. 1) as the patient did not follow the diet at home. Percutaneous renal biopsy under ultrasound control was performed showing focal segmental glomer ulosclerosis without immune deposits. The patient was discharged on a treatment with theophylline, and calcium channel blockers for hypertension, and a hypocaloric diet. After a 20-kg weight reduction proteinuria was less than 1 g/24 h, total protein was 7.1 g/1 and serum creatinine 1.7 mg/dl. Fig. 1 . Evolution of different analytical parameters with weight variation. Discussion Focal segmental glomerulosclerosis has been de scribed associated to sleep apnea syndrome and massive obesity [2], Its pathogenesis may be related to glomerular hyperfunction with maladaptive changes leading to glomerular hypertension and finally focal glomerulo