[Focal segmental glomerulosclerosis--the disease entity or histological type of glomerular injury?]

Abstract

The literature data point to the possibility of misinterpretation of the term focal segmental glomerulosclerosis, which is used by nephropathologists in histopathologic examination of renal biopsies. This term may reflect the description of nonspecific cicatrisation of glomeruli, or the disease entity characterized by nephrotic syndrome, or gross proteinuria, progression to renal insufficiency, resistance to sterydotherapy and recurrence in transplant kidney The aim of the study to present the difficulties in the histological assessment of glomerular sclerotic lesions, and to emphasize the importance of close cooperation between clinicians and pathologists in the interpretation of morphological diagnosis. The histopatologic diagnosis of focal segmental glomerulosclerosis must contain comment if this term reflects description of the type of glomerular injury or the specific disease entity. Definite diagnosis of focal segmental glomerulosclerosis requires a representative renal biopsy specimen, possibility to evaluate renal tissue using light microscopy, immunofluorescence, electron microscopy and the integration of morphological changes with clinical data. Histological picture of the renal tissue do not allow differentiating idiopathic and secondary focal segmental glomerulosclerosis. The proper interpretation of focal and segmental glomerular sclerotic lesions needs collaboration between nephrologists and pathologists.