Resolution of proteinuria in a patient with focal segmental glomerulosclerosis following BiPAP initiation for obesity hypoventilation syndrome

Associations between secondary focal segmental glomerulosclerosis and both obesity and obstructive sleep apnea have been previously described. Current theory suggests obesity induces glomerular hyperfiltration, leading to glomerulosclerosis. We describe a case of focal segmental glomerulosclerosis in the setting of severe obesity and obstructive sleep apnea with complete resolution of heavy proteinuria following treatment with bi-level positive airway pressure. The patient's proteinuria resolved completely with treatment of obstructive sleep apnea although the patient remained morbidly obese.