**2. Clinical Consequences**

The clinical consequences of obesity on the kidneys, with or without metabolic abnormalities, involve both renal function and structures, Figure 2. Higher prevalence of urinary albumin excretion, sub-nephrotic syndrome, nephrolithiasis, increased risk of developing CKD, and progression to ESKD have been identified as being associated with obesity and having a relevant clinical impact. In renal replacement therapy and kidney transplantation, both the availability of donors and graft survival are also influenced by obesity. At the time of estimating the association and the impact of obesity on renal disease, the presence of sarcopenia, a not infrequent condition, can be misleading, since it can lead to underestimating obesity [54]. Therefore, other parameters beyond BMI should be considered [55].


**Figure 2.** Obesity-associated structural lesions and functional disorders. FSGS: focal segmentary glomerulosclerosis.
