Focal glomerulosclerosis in idiopathic membranous glomerulonephritis

Abstract

The significance of the finding of focal glomerulosclerosis (FGS) in idiopathic membranous glomerulonephritis (MGN) is uncertain. Twenty-seven patients with mixed FGS and MGN (MGN-FGS) were compared to 25 patients with MGN alone (generally matched for age, sex and stage of glomerular lesion) with respect to pathology, presenting clinical and laboratory features, and course of disease. Biopsies from the MGN-FGS patients showed significantly more extensive tubulointerstitial disease (P less than 0.001) than did those with MGN alone. At the time of biopsy, the MGN-FGS group had a significantly higher proportion of patients with hypertension (P = 0.006) and microhematuria (P = 0.006), a marginally higher percentage of patients with the nephrotic syndrome (P = 0.051), and a greater mean 24-hour urinary protein excretion (P = 0.004). A similar proportion of patients in each group were treated with either prednisone alone or prednisone with an immunosuppressive. Forty-eight percent of MGN-FGS patients and 13% of the MGN patients developed established renal failure in the follow-up period (P = 0.008). The renal survival rate for the MGN-FGS group was significantly lower at 24 months (0.61 vs. 0.93, P less than 0.05), 60 months (0.48 vs. 0.88, P less than 0.025), and over the entire follow-up period (P less than 0.05). The results indicate that FGS in MGN is associated with a significantly poorer prognosis than MGN without this lesion.

Management of Membranous Nephropathy

“…Also new are data suggesting that the configuration of the immune composite on electron microscopy may be of help in indicating those who are most likely to respond to treatment. Patients with homogeneous electron dense deposits, i.e., synchrony of the deposits at a single stage, do better than patients with heterogeneous (multistage) deposits on electron microscopy (19,20).…”

Focal segmental glomerulosclerosis is not a sufficient predictor of renal outcome in patients with membranous nephropathy

“…A total of seven studies, including the present study, fulfilled the inclusion criteria [9][10][11][12]14,15] All studies were retrospective by design. Detailed data of one study were unavailable [14].…”

“…In previous studies, we have found that urinary b2-microglobulin (b2M) accurately predicts prognosis in patients with iMN [6][7][8]. Recent studies have provided evidence that morphological parameters-specifically focal segmental glomerulosclerosis (FSGS)-may be used as prognostic parameter [9][10][11][12]. In the present study, we have evaluated FSGS as prognostic parameter in patients with iMN.…”

Effect ofIL-6C-572G polymorphism on idiopathic membranous nephropathy risk in a han chinese population

“…Histological staging was based on histological lesion, including glomerular lesion, 15 tubulointerstitial lesion, focal glomerulosclerosis, 16 and fibrointimal lesion. Biopsy specimens were reviewed by a nephropathologist unaware of patients' clinical history, renal function, and IL-6 gene SNP (C-572G).…”