PRELIMINARY DESCRIPTION OF FOCAL SEGMENTAL GLOMERULOSCLEROSIS IN PATIENTS WITH RENOVASCULAR DISEASE

Background Primary and secondary forms of focal segmental glomeruloscl erosis (FSGS) are common causes of glomerular proteinuria. Secondary f orms of FSGS seem to be the result of adaptive changes that follow a r eduction in renal mass. We saw an elderly patient with severe bilatera l renal vascular disease (RVD) who had FSGS on percutaneous biopsy. To find out whether elderly patients with atherosclerotic RVD are predis posed to the development of FSGS, we reviewed all cases of FSGS at our institution between 1990 and 1995. Methods We identified 59 cases of biopsy-proven FSGS and examined clinical, histological, and radiograph ic records. Findings Of the 59 patients, 24 were older than 50 years; eight of these had RVD. No patient under the age of 50 had RVD. Seven of the eight patients with RVD and FSGS had substantial proteinuria at presentation. All had typical glomerular lesions with focal segmental tuft collapse and synechiae; other glomeruli were hypertrophic. All p atients showed further decline in renal function on follow-up. Interpr etation The association of FSGS and RVD may represent an under-recogni sed aetiology of significant proteinuria in elderly patients.