Focal Glomerulosclerosis — A Review

Abstract

The precise definition of a disease entity is often very difficult, and all we are doing in glomerulonephritis is dividing it up into a number of what we hope are useful categories. It seems to me that the criticisms which have been levelled at the acceptance of focal glomerulosclerosis as an entity, can equally be used to attack a well-accepted category such as membranous glomerulonephritis. It is suggested that focal sclerosing lesions can be produced by different aetiological factors, but this is also true of membranous glomerulonephritis. It has been pointed out that patients with segmental sclerosing lesions do not always have a uniform prognosis and yet we know that 25% of membranous cases may recover spontaneously. It has also been pointed out that focal sclerosing lesions may complicate other patterns of disease. This also applies to the membranous pattern which can be seen in lupus nephritis and superimposed on mesangio-capillary glomerulonephritis. Finally we now have quite good evidence of recurrence of focal glomerulosclerosis in renal transplants, yet this is rare in membranous glomerulonephritis. On this evidence it would seem that focal glomerulosclerosis is at least as reliable an entity as membranous glomerulonephritis. For the purpose of this account I intend to ignore focal global glomerulosclerosis which several workers have shown to have the same prognosis as minimal change disease.