*2.2. Sub-Nephrotic Syndrome*

Obesity-related glomerulopathy is a characteristic syndrome which is categorized by the presence of sub-nephrotic proteinuria, glomerulopathy, and renal function loss. Patients usually do not have proteinuria at the level of nephrotic syndrome in 30% of subjects [63] in which there is sub-nephrotic proteinuria in the absence of edema, hypoalbuminemia, and less hyperlipidemia. The reason for the differences between this syndrome and typical nephrotic syndrome is the indolent development of compensating mechanisms over many years. These mechanisms reduce or limit the systematic and metabolic impact, increasing hepatic synthesis of albumin and other proteins [64]. This is in contrast with nephrotic syndrome due to other etiologies. Biopsies in obese patients reveal glomerulomegaly and some of them also develop an adaptive form of focal segmental glomerulosclerosis, increasing the risk of progression to renal dysfunction [65].
