**3.2 Bariatric surgery in nephrotic syndrome due to obesity**

About 30 years ago, the initial descriptions of nephropathy associated with obesity were published, which were followed by lots of reports of kidney disease in obese subjects without diabetes. Obesity-associated nephrotic syndrome has been described as a glomerulopathy that presents with a variable kind of proteinuria. The mechanisms of renal injury are attributed to the body adapting adversely to the rise in the excretory load, salt retention, and the direct or indirect effects of hyperinsulinemia/insulin resistance and renal lipotoxicity. The most commonly used treatment for nephropathy associated with obesity stresses on the use of antiproteinuric agents, with ACE inhibitors and angiotensin II receptor blockers, which in turn improve sensitivity to insulin and protect the kidneys and cardiovascular system. Bariatric surgery has been accepted as one of the essential procedures for achieving these goals but involves a reasonable risk [20].

Ramirez et al. in their report of two cases of nondiabetic obese patients with FSGS stated that there was an effective reduction of body weight by bariatric surgery and this was successfully accompanied by sustained remission of proteinuria allowing significant reduction or total removal of blockers of the renin-angiotensin system. Huan et al. also reported a case of obesity-related nephropathy and FSGS on renal biopsy. The patient underwent bariatric surgery and attained successful weight reduction with significant decrease in proteinuria and stabilization of renal function [21].
