Choung HYG, et al. - Given that morbid obesity, defined as body mass index (BMI) ≥40 kg/m², affects approximately 8% of United States adults and is a recognized risk factor for chronic kidney disease (CKD), researchers presented the first focused biopsy-based study analyzing the range of kidney diseases in this population. Among 3263 native kidney biopsies interpreted at Columbia University in 2017, 248 biopsies from morbidly obese patients were identified. They observed that the strongest predictor of non-obesity related glomerulopathy (ORG) lesions was estimated glomerular filtration rate (eGFR) <30 ml/min per 1.73 m², and presentation with nephrotic syndrome or acute kidney injury was more common in non-ORG than ORG. Data reported that 167 subjects had other kidney diseases alone, without ORG, most commonly diabetic nephropathy, acute tubular necrosis, hypertensive nephrosclerosis, IgA nephropathy, membranous nephropathy, and lupus nephritis. In the morbidly obese population, outcomes exhibited an unexpectedly broad spectrum of kidney pathology beyond metabolic syndrome-associated disorders and highlighted the importance of kidney biopsy to guide management and prognosis.