​Pathology - Focal Segmental Glomerulosclerosis

​Pathology - Focal Segmental Glomerulosclerosis
Often of unknown cause, but can also be linked to heroin use, severe obesity, reflux nephropathy, and HIV infection.
Typically manifests in elderly individuals.

Pathology  
Light microscopy shows sclerosis in the capillary tufts of deep juxtaglomerular glomeruli with focal and segmental distribution, along with hyalinosis.
Immunofluorescence detected IgM and C3 in sclerotic lesions.

Electron microscopy showing the fusion of epithelial foot processes.

Symptoms and signs 
Nephrotic syndrome presents with edema and proteinuria, with a more severe manifestation observed in individuals with HIV and IV drug users.
Lab results show that 80% of individuals had microscopic hematuria upon initial examination.

Treatment includes corticosteroids. In cases when individuals do not respond to steroids, immunomodulators like cyclosporine or tacrolimus may be used. ACE inhibitors can also be investigated to minimize urine protein loss.


Patients often develop end-stage renal disease (ESRD) within 5-10 years, however the progression can vary.