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        "resumen" => "<p class="elsevierStylePara">La obesidad est&#225; relacionada con la aparici&#243;n temprana de glomerulomegalia&#44; las alteraciones hemodin&#225;micas del ri&#241;&#243;n hiperfiltrante y el aumento de la albuminuria&#44; s&#237;ntomas que son reversibles con una p&#233;rdida de peso&#46; Por el contrario&#44; las lesiones patol&#243;gicas de la glomeruloesclerosis focal y segmentaria se desarrollan en modelos experimentales de obesidad mantenida y se observan en pacientes con obesidad m&#243;rbida que presentan proteinuria masiva&#46; Adem&#225;s&#44; diferentes estudios observacionales&#44; transversales y longitudinales han demostrado que la obesidad supone un factor de riesgo independiente de la aparici&#243;n&#44; el empeoramiento&#44; y la escasa respuesta al tratamiento de la enfermedad renal cr&#243;nica &#40;ERC&#41;&#44; incluso despu&#233;s de ajustar por variables de confusi&#243;n&#44; incluido el s&#237;ndrome metab&#243;lico&#44; la diabetes y la hipertensi&#243;n&#44; las principales causas de la enfermedad renal cr&#243;nica&#46; En los pacientes con enfermedad renal cr&#243;nica que presentan sobrepeso y obesidad debe considerarse la instauraci&#243;n precoz de una dieta para reducir peso y la cirug&#237;a bari&#225;trica&#44; en caso de ser necesaria&#46;</p>"
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