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Currently filtering by tag: Focal segmental glomerulosclerosis

Diagnose This (March 25, 2019)

Nephrotic Syndrome, Arkana Laboratories, renal pathology, kidney injury
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Focal Segmental Glomerulosclerosis (FSGS), Tip Variant

This biopsy was performed on a 9-year-old female with no significant past medical history, who presents with nephrotic syndrome. The serum creatinine at the time of the biopsy was 0.7 mg/dl. The UPCR was 9.6 g/g. Serum albumin was 2.1 g/dl. Complement levels and ANA were normal/negative. The biopsy shows glomeruli with minimal mesangial matrix expansion and hypercellularity (Fig 1), in the absence of segmental glomerulosclerosis or proliferative lesions. Immunofluorescence was negative for IgA, IgG, IgM, C3, C1q and kappa and lambda light chains (not shown). Electron microscopy shows widespread blunting, widening and effacement of epithelial foot processes (Fig 2),...

Membranous with FSGS

Some patients with membranous glomerulopathy also have associated focal segmental glomerulosclerosis (FSGS) lesions. The glomerulus in this biopsy image, for example, shows a prominent area of segmental sclerosis surrounded by mildly thickened capillary loops which have granular IgG deposits by immunofluorescence (see inset). As in other renal diseases, studies have linked the presence of FSGS lesions in patients with membranous glomerulopathy to more severe disease (e.g. higher levels of proteinuria). Dumoulin A, Hill GS, Montseny JJ, Meyrier A. Clinical and morphological prognostic factors in membranous nephropathy: significance of focal segmental glomerulosclerosis. Am J Kidney Dis. 2003 Jan;41(1):38-48. PMID: 12500220.

Foot Process Effacement and Focal Segmental Glomerulosclerosis

Knowing whether a patient has clinical nephrotic syndrome and knowing the degree of podocyte foot process effacement can be helpful diagnostic clues in separating “primary” from “secondary” forms of focal segmental glomerulosclerosis (FSGS). For example, in a patient with the nephrotic syndrome whose biopsy shows FSGS lesions and no significant immune deposits by immunofluorescence, the presence of global effacement of podocyte foot processes by electron microscopy (as seen in Fig 1) provides support for a “primary” FSGS (see reference). Sethi S et al. Focal and segmental glomerulosclerosis: clinical and kidney biopsy correlations. Clin Kidney J. 2014 Dec;7(6):531-7.PMID: 25503953.

Focal Segmental Glomerulosclerosis Not Otherwise Specified

Focal segmental glomerulosclerosis (FSGS) is a nonspecific pattern of glomerular scarring in which a subset of the glomeruli show partial involvement of the glomerular tuft. It should not be confused with a specific disease. The differential diagnosis is too long to include here but includes genetic etiologies, primary injury to podocytes, and adaptive responses to diseases such as hypertension and obesity. Clinicopathologic correlation can be useful to identify patients with primary FSGS. Specifically, primary FSGS is more likely if >80% foot process effacement is present by electron microscopy and the clinical evaluation reveals nephrotic syndrome (not just nephrotic-range proteinuria) including...

Renal Cell Carcinoma and Adjacent Kidney

A patient with nephrotic-range proteinuria and declining renal function underwent total nephrectomy for a conventional clear cell renal cell carcinoma (Fig 1). In the non-neoplastic kidney tissue, focal segmental glomerulosclerosis with collapsing features was present (Fig 2). Careful evaluation of the adjacent non-neoplastic kidney can provide important clues to current or potential causes of decreased renal function in patients who undergo nephrectomy. Here, Bonsib and Pei discuss the topic of evaluating non-neoplastic kidney in tumor nephrectomy specimens: