Figure 28

Light and immunofluorescent microscopy in focal segmental glomerulosclerosis (FSGS). Patients with FSGS exhibit massive proteinuria (usually nonselective), hypertension, hematuria, and renal functional impairment. Patients with nephrotic syndrome often are not responsive to corticosteroid therapy. Progression to chronic renal failure occurs over many years, although in some patients renal failure may occur in only a few years. A, This glomerulopathy is defined primarily by its appearance on light microscopy. Only a portion of the glomerular population, initially in the deep cortex, is affected. The abnormal glomeruli exhibit segmental obliteration of capillaries by increased extracellular matrix-basement membrane material, collapsed capillary walls, or large insudative lesions. These lesions are called hyalinosis (arrow) and are composed of immunoglobulin M and complement C3 (B, IgM immunofluorescence). The other glomeruli usually are enlarged but may be of normal size. In some patients, mesangial hypercellularity may be a feature. Focal tubular atrophy with interstitial fibrosis invariably is present.

0 0

Post a comment