A FREQUENT PATHWAY TO GLOMERULOSCLEROSIS - DETERIORATION OF TUFT ARCHITECTURE PODOCYTE DAMAGE SEGMENTAL SCLEROSIS

Lesions in glomerular architecture include mesangial expansion, capill ary ballooning, capillary unfolding and microaneurysm formation. Such lesions appear to develop in response to mechanical overextension. A f requent pathway to segmental glomerulosclerosis starts from capillary ballooning and unfolding. Podocytes supporting those deranged capillar ies are exposed to increased mechanical stress. This may lead to podoc yte injury terminating in detachments from the GEM. Naked GEM areas at peripheral capillary loops allow the attachment of parietal cells to the GEM, i.e. the formation of a tuft adhesion to Bowman's capsule. An adhesion has a strong tendency to progress to segmental sclerosis.