American Board of Internal Medicine (ABIM) Certification Practice Exam

What is one of the contributing factors to the progression of focal segmental glomerulosclerosis in obese patients?

1. Weight loss

2. Increased carbohydrate intake

3. Lack of exercise

4. Excessive protein intake

The correct answer is: Weight loss

The progression of focal segmental glomerulosclerosis (FSGS) in obese patients is influenced by various metabolic and environmental factors. Weight loss is particularly significant as it can reduce the overall metabolic burden on the kidneys. In obesity, there is often an upregulation of the renin-angiotensin-aldosterone system, which can lead to glomerular hypertension and subsequent injury, resulting in conditions such as FSGS. When an obese individual loses weight, it can alleviate some of this pressure on the kidneys and improve metabolic health, potentially slowing or mitigating the progression of kidney disease. In contrast, increased carbohydrate intake, lack of exercise, and excessive protein intake are associated with metabolic syndrome and poor kidney outcomes. Increased carbohydrate intake can exacerbate insulin resistance, contributing to further weight gain and kidney stress. A lack of exercise can compound obesity-related health issues by failing to promote weight loss and improve cardiovascular health. Excessive protein intake can lead to greater renal workload due to the need to excrete nitrogenous waste, which may worsen glomerular injury in those with underlying kidney conditions. Therefore, promoting weight loss stands out as a critical factor in managing and potentially reducing the progression of FSGS in patients with obesity.