Obesity constitutes a strong risk factor for the development of chronic kidney disease. This review examines the epidemiology, clinicopathologic presentation, and proposed mechanisms for chronic kidney disease in the obese patient. Obesity-associated nephropathy displays a continuum that evolves from glomerulomegaly to glomerulosclerosis and from mild to severe proteinuria in the absence of significant edema and hypoalbuminemia. The disease may well progress into end-stage renal disease unless weight management strategies are used. The renal effects of different obesity treatments are reviewed. Interestingly, the reversibility of the disease throughout most of its stages highlights the benefit of weight loss strategies in this population. Nephrolithiasis as it relates to obesity also is examined in addition to other pertinent comorbidities in obesity such as incontinence, calciphylaxis, and the renal complications of bariatric procedures.
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