Advertisement

Virchows Archiv

, Volume 460, Issue 4, pp 429–435 | Cite as

A spectrum of morphologic lesions of focal segmental glomerulosclerosis by Columbia criteria in human immunodeficiency virus infection

  • Shane M. MeehanEmail author
  • Lisa Kim
  • Anthony Chang
Original Article

Abstract

The Columbia working classification of focal segmental glomerulosclerosis (FSGS) identifies five types of glomerular lesions, designated collapsing (COLL), cellular (CELL), glomerular tip lesion (GTL), perihilar (PH), and not otherwise specified (NOS) variant lesions. FSGS COLL and non-collapsing variants of FSGS are described in human immunodeficiency virus (HIV)-associated kidney disease. This study examined the range and relationships of Columbia-type segmental sclerosing lesions in biopsies from patients with HIV infection. We identified 47 renal biopsies from 46 patients with HIV infection obtained over an 8-year period. Twenty-seven biopsies from 26 patients had FSGS. Sixteen biopsies had FSGS COLL (59.3%), 3 had CELL (11.1%), 5 had NOS (18.5%), 2 had PH (7.4%), and 1 had GTL (3.7%) by the Columbia classification. Biopsies had more than one type of Columbia FSGS lesion in 63% and one type in 37%. Single types of FSGS lesions were identified in eight of eight biopsies with ≤10 glomeruli. Combinations of lesions were observed in 17 of 19 (89.5%) with >10 glomeruli, and the coincidence of COLL, CELL, and NOS lesions was not random. NOS, COLL, and CELL morphologic lesions of FSGS frequently coexist in kidney biopsies from HIV+ patients. Combined patterns of FSGS suggest that lesions identified by Columbia criteria may be part of a spectrum of responses to injury in the setting of HIV infection.

Keywords

HIV infection Focal segmental glomerulosclerosis Collapsing glomerulopathy 

Notes

Conflict of interest

We declare that we have no conflict of interest.

References

  1. 1.
    D'Agati VD, Fogo AB, Bruijn JA, Jennette JC (2004) Pathologic classification of focal segmental glomerulosclerosis: a working proposal. Am J Kidney Dis 43:368–382PubMedCrossRefGoogle Scholar
  2. 2.
    D'Agati VD (2003) Pathologic classification of focal segmental glomerulosclerosis. Semin Nephrol 23:117–134PubMedCrossRefGoogle Scholar
  3. 3.
    D'Agati VD (1994) The many masks of focal segmental glomerulosclerosis. Kidney Int 46:1223–1241PubMedCrossRefGoogle Scholar
  4. 4.
    Stokes MB, Valeri AM, Markowitz GS, D'Agati VD (2006) Cellular focal segmental glomerulosclerosis: clinical and pathologic features. Kidney Int 70:1783–1792PubMedCrossRefGoogle Scholar
  5. 5.
    Pollack MR (2003) Inherited podocytopathies: FSGS and nephrotic syndrome from a genetic viewpoint. J Am Soc Nephrol 13:3016–3023CrossRefGoogle Scholar
  6. 6.
    Meyrier A (2005) Mechanisms of disease: focal segmental glomerulosclerosis. Nature Clin Pract 1:44–54CrossRefGoogle Scholar
  7. 7.
    Schwartz MM, Lewis EJ (1985) Focal segmental glomerular sclerosis: the cellular lesion. Kidney Int 28:968–974PubMedCrossRefGoogle Scholar
  8. 8.
    Howie AJ, Pankhurst T, Sarioglu S, Turhan N, Adu D (2005) Evolution of nephrotic associated focal segmental glomerulosclerosis and relation to the glomerular tip lesion. Kidney Int 67:987–1001PubMedCrossRefGoogle Scholar
  9. 9.
    Stokes MB, Markowitz G, Lin J, Valeri AM, D'Agati VD (2004) Glomerular tip lesion: a distinct entity within the minimal change disease/focal segmental glomerulosclerosis disease spectrum. Kidney Int 65:1690–1702PubMedCrossRefGoogle Scholar
  10. 10.
    D'Agati VD, Suh J-L, Carbone L, Cheng J-T, Appel G (1989) Pathology of HIV-associated nephropathy: a detailed morphologic and comparative study. Kidney Int 35:1358–1370PubMedCrossRefGoogle Scholar
  11. 11.
    Corwin HL, Schwartz MM, Lewis EJ (1988) The importance of sample size in the interpretation of the renal biopsy. Am J Nephrol 8:85–89PubMedCrossRefGoogle Scholar
  12. 12.
    Nebuloni M, Barbiano di Belgioso G, Genderini A, Tosoni A, Landriana N, Hidempergher M, Zerbi P, Vago L (2009) Glomerular lesions in HIV positive patients: a 20 year biopsy experience from Northern Italy. Clin Nephrol 72:38–45PubMedGoogle Scholar
  13. 13.
    Berliner AR, Fine DM, Lucas GM, Hazifur Rahman M, Racusen LC, Scheel PJ, Atta MG (2008) Observations on a cohort of HIV infected patients undergoing native renal biopsy. Am J Nephrol 28:478–486PubMedCrossRefGoogle Scholar
  14. 14.
    Latour M, Amin MB, Billis A, Egevad L, Grignon DJ, Humphrey PA, Reuter VE, Sakr WA, Srigley JR, Wheeler TM, Yang XJ, Epstein JI (2008) Grading of invasive cribriform carcinoma on prostate needle biopsy. Am J Surg Pathol 32:1532–1539PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Department of PathologyUniversity of ChicagoChicagoUSA

Personalised recommendations