FOCAL SEGMENTAL

GLOMERULOSCLEROSIS

DONA M JOY
FOCAL SEGMENTAL
GLOMERULOSCLEROSIS
 As the name implies ,the lesion is characterized
by sclerosis of some glomeruli(focal);and in the
affected glomeruli only a portion of capillary tuft
is involved(segmental).
AETIOLOGY
PATHOGENESIS
 PATHOGENESIS
 Effacement of podocytes
 Entrapment of plasma proteins
(hyperpermiability)
 Hyalinosis and sclerosis

 Mesangial proliferation

 Segmental increase of mesangial matrix with

obliteration of the capillaries ,sclerosis,
hyalinosis, foam cells and segmental scarring,
adhesion between the glomerular tuft and
bowman's capsule.
 TYPES
o Tip variant :the glomerular scarring and damage
occurs at the tip of the glomerulus.
o Perihilar variant :the scar forms at the hilum of
the glomerulus.
o Collapsing variant :scarring quickly affects the
entire glomerulus causing it to collapse.
o Cellular variant: overabundance of cells that
make up the glomerulus.as these cells accumulate,
the blood vessels narrow and eventually close off
completely.
o FSGS not otherwise specified(classic)
TYPES
INVESTIGATIONS

 Renal biopsy (gold standard)

 Urine analysis

 Urine protein measurement(24hr)

 Serologic studies for infection and immune

abnormalities
 Renal ultrasonography
 TREATMENT

 ACE inhibitors and/or ARB :reduce proteinuria

by reducing the systemic blood pressure , by
reducing intraglomerular pressure and also by
direct action on podocytes.
 Corticosteroid therapy(1mg/kg/day):to
patients with nephrotic range proteinuria.
 In steroid dependant cases cyclophosphamide
or cyclosporine or tacrolimus.
 50% of patients with steroid resistant FSGS
respond to combination of cyclosporine
/tacrolimus with steroids(oral prednisolone 0.1
mg/kg/day).
 Many patients diagnosed with FSGS will
eventually progress to kidney failure , kidney
transplant is the treatment option.
THANK YOU