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Nephrol Dial Transplant (1993) 8: 590-599
© 1993 European Renal Association-European Dialysis and Transplant Association

research-article

Different clinicopathological types of segmental sclerosing glomerular lesions in adults

A. J. Howie1,, S. J. Lee1, N. J. Green1, K. M. Newbold1, T. Kizaki1, A. Koram2, N. T. Richards2, J. Michael2 and D. Adu2

1Department of Pathology, University of Birmingham, Queen Elizabeth Hospital Birmingham, UK 2Department of Nephrology, Queen Elizabeth Hospital Birmingham, UK

Correspondence and offprint requests to: Correspondence and offprint requests to: Dr A. J. Howie, Department of Pathology, University of Birmingham, The Medical School, Birmingham Bl5 2TT, UK

Renal biopsies and kidneys from 111 adult patients with segmental sclerosing glomerular lesions were put into different morphological groups by pathologists unaware of clinical findings. ‘Overload changes’ (n= 11) were large glomeruli with hilar lesions. Ten of these patients had reduced renal mass. In the ‘glomerular tip lesion’ (n=10) there were changes at the tubular origin in otherwise normal glomeruli. All patients in this group had the nephrotic syndrome, completely responsive to steroids. ‘Mesangial hypercel-lularity with diffuse segmental changes at the glomerular tip’, corresponding to ‘early classical focal segmental glomerulosclerosis’ (n=18), differed from the glomerular tip lesion in that glomeruli were larger and hypercellular. Most patients with this classification had the nephrotic syndrome, several were given additional immunosuppression, and less than half had complete remission. ‘Diffuse multiple segmental lesions’, corresponding to ‘late classical focal segmental glomerulosclerosis’ (n= 16), presented usually with the nephrotic syndrome, and most of these patients had no response to immunosuppression. Unlike most other groups, in ‘focal segmental sclerosing lesions’ (n = 56) there were genuinely focal lesions, not in every glomer-ulus. Most patients had asymptomatic proteinuria. Pathological study is able to classify segmental lesions that would often be grouped as ‘focal segmental glomerulosclerosis’ into types with different pathogenesis, clinical findings, appropriate treatment, response to treatment, and prognosis.

Keywords: glomerulus; nephrotic syndrome; proteinuria; segmental sclerosing lesions


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