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Article Review/Hyperlink
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Thadhani R, Pascual M, Nicheleit V, Tolkoff-Rubin N, Colvin R
Preliminary description of focal segmental glomerulosclerosis
in patients with renovascular disease
Lancet
(Jan) 347:231-233 1996

These authors carefully reviewed 59 cases of biopsy-proven focal segmental
glomerulosclerosis (FSGS) from 1990 - 1995 to investigate a possible
association with renovascular disease (RVD). Of 24 patients older than 50
years old, 8 were found to have RVD; none of the 25 patients under 50 had
evidence for RVD. The patients had 3.5 - 7.1 grams of proteinuria, but
edema, hypercholesterolemia and hypoalbuminemia were rare, supporting a
diagnosis of secondary FSGS. The presence of hypertrophied glomeruli
without evidence of collapse also was felt to indicate secondary FSGS.
Arteriolar hyaline changes were common. A previously unrecognized
association between FSGS and RVD was postulated. Renal ischemia leading to
compensatory glomerular hypertrophy and secondary FSGS was suggested to be
a possible mechanism.
Comment: This interesting possible association between RVD and FSGS
has not
previously been reported, and bears further examination. However, a chance
association may be possible in this series. Some patients were referred
for biopsy to assess renal viability prior to renal revascularization or
angioplasty; this implies that a population selected for a high incidence
of RVD was referred for biopsy. If RVD were truly a cause of secondary
FSGS, it is not clear why none of the FSGS patients under 50 years of age
had RVD. Finally, in another model of hyperfiltration and glomerular
hypertrophy-induced nephrosis, diabetic nephropathy, RVD has been found to
be protective against glomerulosclerotic injury in two well documented
"experiments of nature," (Beroniade VC, et al. Unilateral nodular diabetic
glomerulosclerosis: recurrence of an experiment of nature, Am J
Nephrol 7:
55-59, 1987. and Berkman J, Rifkin A: Unilateral nodular diabetic
glomerulosclerosis (Kimmelstiel-Wilson): report of a case. Metabolism
22:
715-722, 1973). (Stephen Pastan MD, Emory University)
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