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16 Diseases of the Kidney and Lower Urinary Tract 471
Bowman
space
Visceral
epithelial Capillary
cell lumen
Post
process Bndothelial
cell
Mesangial
cell
Mesongial
A matrix
Parietal epithelial cell
Bowman space
RBCS
Epithelial cell with loss
of toot processes
Endothelial cell
Mesangial cells
B Mesangial matrix
FIGURE 16.7. Diagrammatic representation of electron microscopic appearance of (a) normal
glomerulus and (b) glomerulus in MCD showing effacement of foot processes.
No electron-dense deposits are seen. Proximal convoluted tubular cells are lipid laden (there-
fore, the disease is also called lipoid nephrosis).
Focal Segmental Glomerulosclerosis (FSGS)
• Typically shows focal (focal indicates involvement of some glomeruli) and segmental (seg-
mental indicates involvement of part of the glomerulus) sclerosis. It has the following types:
1. Idiopathic or primary (10–35% patients)
2. FSGS superimposed on another primary glomerular lesion
3. Renal ablation FSGS (seen with reflux nephropathy and analgesic abuse)
4. Secondary FSGS (seen with heroin abuse/HIV/sickle cell disease)
5. A rare inherited type in which the disease is caused by mutations in genes encoding
for glomerular proteins, eg, podocin and a-actinin.
• Eighty percent patients present with nephrotic syndrome.
• Fifty percent convert to end-stage renal disease.
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