60-year-old male patient with Alport syndrome, microhaematuria and proteinuria of 4 g/day, creatinine 2 mg/dl, urea 123 mg/dl, moderate hearing loss, arterial hypertension treated with enalapril 20 mg, obesity with BMI = 36.26 (P 120 kg, h 1.81 m), altered fasting blood glucose (less than 126 mg/dl), normal glycosylated Hb, dyslipidaemia and hyperuricaemia under treatment. Ex-smoker of one pack a day. Normothyroid. Renal biopsy (performed in 1995): MO (12 glomeruli) focal and segmental glomerular sclerosis evolving to sclerosing glomerulopathy, IF with mild intensity Ig M in mesangium and IgA and M in tubular cylinders. ME 2 glomeruli. Capillary MB with irregular thickening and focal unfolding of the lamina densa. Podocytes with total fusion of pedicels. In one sector, effacement of the glomerular structure with deposition of abundant amorphous material, electron dense. The alterations of the lamina densa are compatible with Alport's disease, the rest of the findings with focal sclerosing glomerulonephritis. Renal ultrasound: RD 95.6 x 52 x 53, RI 99 x 51 x 52. Renal Doppler without alterations.
A low-protein, low-calorie diet was indicated and losartan was added to the treatment at a dose of 75 mg/day (maximum tolerated by the patient). A very slight reduction in proteinuria to 3.6 g/day was observed. Gastric by-pass surgery was performed, and the patient's overall weight decreased by 35 kg, reaching a BMI of 25.6. Nephrological control: creatinine 1.56 mg/dl, proteinuria 0.3 g/day, urea 65 mg/dl and normotension with enalapril 5 mg/d; minimum dose of lipid-lowering agents, normouricemia and normoglycaemia were maintained.
Three years after surgery, the patient's good evolution is related to compliance with treatment (diet), aerobic exercise and clinical-psychological support.

L. Roberto León Instituto de Nefrología Sa Buenos Aires. (Buenos Aires)