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Morphological features of primary focal and segmental glomerulosclerosis.

Focal and segmental glomerulosclerosis (FSGS) is one of the most common and non-specific patterns of glomerular injury encountered in human renal biopsies. The primary form can be considered when there is a nephrotic syndrome without other causes. The majority of authors agree that podocytes play a role in the development of segmental glomerulosclerosis. The lesion begins with cell hypertrophy, foot process effacement, cell body attenuation, pseudocyst formation, cytoplasmic overload with reabsorption droplets and finally detachment of the glomerular basement membrane (GBM). When the GBM is denuded, it comes into contact with the parietal epithelium and parietal epithelial cells will attach to the GBM, leading to a synechia and, finally, sclerosis. Along this zone, parietal epithelial cells rest on hyalin material. Occlusion and collapse of a group of capillaries is observed, with inclusion of foam cells and hyalin deposits. The origin of primary FSGS has not yet been elucidated. Genetic, racial and developmental factors, macrophages, viral factors and circulating factors are being explored and give encouraging results.