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Focal and Segmental Glomerulosclerosis( FSGS).

affecting some but not all glomeruli (focal involvement) and involving only segments of each affected glomerulus(segmental)

Primary ie idiopathic, or secondary GN due to HIV, heroin,IgA nephropathy

there is a higher incidence of hematuria and hypertension in persons with this lesion; their proteinuria is nonselective, and in general their response to corticosteroid therapy is poor

At least 50% of individuals with FSGS develop end-stage renal failure within 10 years of diagnosis

M/E

increased mesangial matrix, obliterated capillary lumens, and deposition of hyaline masses (hyalinosis) and lipid droplets

glomeruli are completely sclerosed (global sclerosis) in late cases

immunofluorescence microscopy often reveals nonspecific trapping of immunoglobulins, usually IgM, and complement

pronounced tubular atrophy and interstitial fibrosis. This advanced picture is difficult to differentiate from other forms of chronic glomerular disease


Focal segmental glomerulosclerosis, PAS stain. A, Low-power view showing segmental sclerosis in one of three glomeruli (at 3 o'clock). B, High-power view showing hyaline insudation and lipid (small vacuoles) in sclerotic area.