Recurrent Focal Segmental Glomerulosclerosis in Renal Allograft Recipients: Role of Human Leukocyte Antigen Mismatching and Other Clinical Variables
Table 1
Pathologic reports of 22 recurrent Focal Segmental Glomerulosclerosis in renal allograft recipients from 1990 to 2007 at Montefiore Medical Center.
No.
LM/IF
EM
(1)
8 G: no global or segmental sclerotic/proliferative lesions IF; 2 G trace IgM mesangial
1 G focal FP effacement, focally swollen endothelial cells, normal GBM
(2)
12 G: 1 globally sclerosed, no segmental sclerotic/proliferative lesions, scant protein reabsorption droplets IF; 1 G negative
2 G diffusely effaced FP, normal GBM
(3)
5 G: tubules with mild atrophy with extensive dilatation/thyroidization with sparse protein reabsorption droplets and mild ATN, with absent inflammation or fibrosis IF; 0 G
1 G with mesangial expansion and diffusely effaced FP, normal GBM
(4)
16 G: no segmental sclerotic/proliferative lesions, focal interstitial chronic inflammation IF; 0 G
3 G focal FP effacement, normal GBM
(5)
5 G: no global or segmental sclerotic/proliferative lesions focal mild interstitial fibrosis IF; 1 G negative
1 G focal FP effacement, normal GBM
(6)
1 G: no global or segmental sclerotic/proliferative lesions focal mild interstitial fibrosis IF; 0 G
1 G focally effaced FP with microvillous change, focal loss of fenestrations, focal areas of prominence of the lamina rara interna of GBM
(7)
2 G: no global or segmental sclerotic/proliferative lesions, tubules 100% intact, no fibrosis IF: 1 G trace mesangial IgM
1 G with focally effaced FP, normal GBM
(8)
25 G: 2 globally sclerosed, with remaining G exhibiting mesangial expansion with increased matrix IF; 1 G with 1+ IgM
2 G with mesangial expansion and diffusely effaced FP, normal GBM
(9)
12 G: no global or segmental sclerotic/proliferative lesions, tubules 100% intact IF; 2 G weak IgG mesangial staining
2 G with focally effaced FP, normal GBM
(10)
7 G: 1 globally sclerosed, one nodule of mesangial matrix, mild tubular atrophy with mild interstitial inflammation IF; 1 G 1+ IgM mesangial
1 G with patchy effacement of FP and focal areas of prominence of the lamina rara interna with mild mesangial expansion and no electron dense deposits
(11)
20 G: majority of normal size and cellularity, but few with mild mesangial expansion with focal thickening of the glomerular basement membrane without “spikes” or “splitting”. 1 G with a central area of hyalinosis IF; 2 G negative
2 G with focal effacement of FP and mild mesangial expansion, normal GBM
(12)
29 G: no global or segmental sclerotic/proliferative lesions, tubules 70% intact with mild atrophy, mild ATN, and mild interstitial fibrosis IF; 2 G with 1+ punctuate mesangial deposits and trace IgM mesangial deposits
1 G with focal effacement of FP and mild mesangial expansion, no electron dense deposit and normal GBM
(13)
12 G: 1 globally sclerotic G, no segmental sclerotic/proliferative lesions, tubules 100% intact, no fibrosis, IF; 2 G with trace + mesangial IgA and + c1q deposits
1 G partial effacement of FP and focally collapsed GBM
(14)
15 G: no global or segmental sclerotic/proliferative lesions IF; 3 G negative
1 G with focal areas of effacement of FP with microvillous transformation and normal GBM
(15)
20 G: 2 G with segmental sclerotic lesions with focal epithelial cell prominence with glomerular capsular adhesions IF; 5 G with 1+ IgM and trace IgA and c1q
1 G with extensively obliterated FP and normal GBM with focally ischemic pleating
(16)
6 G: no global or segmental sclerotic/proliferative lesions IF; 1 G negative
2 G with focal effacement of FP and normal GBM
(17)
19 G: 1 globally sclerotic glomerulus, no segmental sclerotic/proliferative lesions, tubules 100% intact, no fibrosis, IF; 1 G with trace IgM mesangial deposits
1 G with focal areas of effacement of FP with mild mesangial expansion, no electron dense deposit and normal GBM
(18)
7 G: 1 globally sclerotic G, no segmental sclerotic/proliferative lesions, focally increased mesangial matrix, tubules 80% intact, mild tubular atrophy without ATN but with focal protein reabsorption droplets and mild fibrosis, IF; 0 G
1 G with scant mesangial electron dense deposits, extensive effacement of FP, focal swelling of endothelial cells, variably thickened and pleated GBM with apparent expansion of mesangial matrix possibly by collapsing capillary basement membranes
(19)
20 G: 2 globally sclerotic G and 4 segmental lesions with minimal mesangial cells and matrix increase, minimal tubular atrophy, fibrosis, and inflammation, IF; 4 G with 2+ focal IgM, trace IgA, and 1+ and light chains
2 G with rare mesangial and subendothelial electron dense deposits, mild thickening of GBM and intact FP
(20)
7 G: with no segmental sclerotic/proliferative lesions, mildly increased mesangial matrix, tubules 90% intact, with mild fibrosis with focal protein reabsorption droplets IF; 2 G with trace IgM
1 G with focal areas of effacement of FP with mild mesangial expansion, no electron dense deposit and normal GBM
10 G: no segmental sclerotic/proliferative lesions, tubules 80% intact with mild focal atrophy and dilatation with scant protein reabsorption droplets, IF; 2 G with trace c1q
1 G with partially effaced FP, GBM with focal subendothelial lucencies and focally present inflammatory cells in capillary lumens
LM: light microscopy; IF: immunofluorescence for IgG, IgM, IgA, c3, c1q, and light chains, Fibrinogen; EM: electron microscopy; G: glomeruli; GBM: glomerular basement membrane; IgA: immunoglobulin A; IgM: immunoglobulin M; IgG: immunoglobulin G; FP: foot processes of glomerular epithelial cells.
