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Diagnosis: Podocitopathy (morphology of Focal Segmental Glomerulosclerosis)
Segmental sclerosis evidenced in one or several glomeruli, with IF negativa in a patient with nephrotic syndrome, indicates focal segmental glomerulosclerosis (FSGS), a condition that can be found in many types of alterations originating in the glomerulus or in other renal compartments, or even outside the kidney. If there is not possible to determine the etiology we use the term "FSGS". In our patient it is very possible that the etiology is an alteration in podocytes: podocitopathy.
In the early stages of the disease the biopsy may not show segmental lesions and the diagnosis would be "minimal glomerular changes" (MCD). It is not a "transformation" of the initial disease. In these initial stages, in glomeruli without segmental lesions, electron microscopy shows the same findings: effacement or fusion of podocyte processes, so it does not help to differentiate MCD from FSGS at an early stage of the disease.
See the chapter: Focal Segmental Glomerulosclerosis of our Tutorial.
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References
- Jellouli M, Abidi K, Askri M, Ferjani M, Naija O, Hammi Y, Goucha R, Gargah T. Focal segmental glomerulosclerosis in children. Tunis Med. 2016;94(5):356-359. [PubMed link]
- Dhanapriya J, Dineshkumar T, Gopalakrishnan N, Sakthirajan R, Balasubramaniyan T. Clinicopathological correlation and treatment response of primary focal segmental glomerulosclerosis in adults and adolescents. Indian J Nephrol. 2016;26(5):347-351. [PubMed link]
- Lim BJ, Yang JW, Do WS, Fogo AB. Pathogenesis of Focal Segmental Glomerulosclerosis. J Pathol Transl Med. 2016;50(6):405-410. [PubMed link]
- Kuppe C, Moeller MJ. Focal segmental glomerulosclerosis: it may no longer be all about podocytes. Kidney Int. 2016;90(4):905. [PubMed link]