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FSGS Tip Lesion – Secondary

The patient is a 64-year-old male with a history of diabetes mellitus, hypertension, and hyperlipidemia, who presents with an increased creatinine of 1.8 mg/dl and proteinuria (UPCR 2.5 g/g). Serologic workup is completely negative. A renal biopsy was performed and shows nodular glomerulosclerosis (Fig 1) and arteriolar hyalinosis characteristic of diabetic glomerulopathy. Additionally, the glomeruli focally show areas of segmental glomerulosclerosis associated with endocapillary foam cells. These lesions are located at the take-off point of the proximal tubule (Fig 1) and reminiscent of the glomerular lesions seen in the tip variant of FSGS. Electron microscopy shows mesangial matrix expansion, mostly...

FSGS Tip Lesion

This biopsy is from a 35-year-old male with no significant medical history, who presents with sudden onset nephrotic syndrome. At presentation, the UPCR was 8.2 g/g and the serum albumin was 1.1 g/dl. Renal function was preserved (SCr 1.1 mg/dl). The biopsy shows frequent areas of segmental glomerulosclerosis (FSGS), associated with endocapillary foam cells and epithelial cell capping, predominantly involving the takeoff point of the proximal tubule (fig 1). Focally, the areas of segmental sclerosis herniate into the proximal tubule. Immunofluorescence is completely negative within the glomeruli, and electron microscopy (fig 2) shows diffuse epithelial foot process effacement. The findings...