PubMed · 15698461
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Mark Haas. 2005. The glomerular tip lesion: what does it really mean?. https://doi.org/10.1111/j.1523-1755.2005.00188.x
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The entity of focal segmental glomerulosclerosis (FSGS), oddly, includes several distinct changes involving glomeruli that need not be focal, segmental, or even sclerotic. It is fitting to rethink our nosological approach to FSGS, which has focused on descriptive morphological entities. Rather, we should consider them as 'podocytopathies' - diseases with an etiological commonality involving injury to the podocyte.
A 48-year-old man presented with malignant hypertension and massive proteinuria. Renal angiography showed complete obstruction of the left renal artery and 99mTc-mercaptoacetylglycine (MAG3) renography showed a nonfunctioning left kidney. Percutaneous transluminal renal angioplasty of the left renal artery was unsuccessful; hence, the patient underwent left nephrectomy because of uncontrolled hypertension and proteinuria. Histological examination of a right kidney specimen revealed lesions of focal segmental glomerulosclerosis with benign nephrosclerosis. In contrast, histology of the left kidney showed typical ischemic kidney with hypertrophy of arteriolar smooth muscle cells. The patient responded favorably to the nephrectomy, as his blood pressure and urinary protein dramatically decreased with no antihypertensive medication. This case illustrates the heterogeneous effect of the renin-angiotensin system on either kidney in patients with renovascular hypertension due to unilateral renal artery stenosis.