Diagnostic Workup for Obesity-Related Glomerulopathy

Authored by Sourabh Sharma, published on 2026-11-12 13:01:52.0

  1. Verify Obesity Threshold and Stratify ORG Risk Factors
    • Measure BP, eGFR, UACR/UPCR, and Urinalysis; Confirm Abnormalities
      • Which Persistent Kidney Screening Pattern Is Present?
        • Provisional Stage 0: Hyperfiltration With Absent or Low-Grade Proteinuria
        • No Current ORG Evidence: Continue Periodic Kidney Screening
        • Characterize Proteinuria, Red Flags, and Alternative Kidney Causes
          • Alternative Cause or Atypical ORG Feature Identified?
            • Follow the Alternative Glomerular or CKD Diagnostic Pathway
            • Refer to Nephrology for Suspected Clinical ORG
              • Is Kidney Biopsy Appropriate and Feasible?
                • Obtain Kidney Biopsy With LM, IF, and EM
                  • Do All Five Essential ORG Criteria Apply?
                    • Assess BP, Insulin Resistance, and Retinopathy; Add Optional PUFT/RSF Imaging and Investigational Biomarkers if Available
                      • Document Supportive ORG Findings as Confidence Modifiers
                        • Confirm Biopsy-Proven Obesity-Related Glomerulopathy
                          • Assign the Proposed Clinicopathologic ORG Stage
                            • Stage 1: Early ORG With Glomerulomegaly
                            • Stage 2: Established ORG With Perihilar FSGS
                            • Stage 3: Progressive ORG With CKD
                            • Stage 4: Advanced ORG With Severe CKD
                            • Discordant Features: Nephrology Adjudication of Proposed Stage
                    • Reclassify and Follow the Appropriate Kidney Disease Pathway
                • Classify Probable ORG; Reassess the Need for Biopsy
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