RENAL-ARTERY STENOSIS AND UNILATERAL FOCAL AND SEGMENTAL GLOMERULOSCLEROSIS

Focal and segmental sclerosed lesions in the glomeruli are found in se veral pathological entities and more often are found in the corticomed ullary junction where renal blood flow and filtration pressure is maxi mal, Experimental data suggest that hyperfiltration injury results in focal and segmental glomerulosclerosis (FSGS). In keeping with this co ncept, malignant hypertension is a known cause of nephrotic-range prot einuria and nephrotic syndrome patholobically represented by FSGS. We report a case of unilateral renal artery stenosis associated with neph rotic syndrome and FSGS in the contralateral kidney only, The kidney w ith the stenosed renal artery showed normal glomeruli with juxtaglomer ular hyperplasia, suggesting that protection from hyperfiltration inju ry was provided by the presence of high-grade stenosis, Serum creatini ne concentration, blood pressure, and proteinuria normalized after aor to-renal bypass surgery. This case shows the importance of hemodynamic factors on the pathogenesis of secondary FSGS and the progression of renal disease, (C) 1997 by the National Kidney Foundation, Inc.