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Abstract: FR-PO1115

Clinical Implications on Simple Attachment and Endothelial Damage in the Glomeruli of Adult Nephrotic Focal Segmental Glomerulosclerosis (FSGS): A Retrospective Cohort Study

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials


  • Ozeki, Takaya, Nagoya University Graduate School of Medicine, Nagoya, Japan
  • Nagata, Michio, University of Tsukuba, Tsukuba, Japan
  • Katsuno, Takayuki, Nagoya University Graduate School of Medicine, Nagoya, Japan
  • Kato, Sawako, Nagoya University Graduate School of Medicine, Nagoya, Japan
  • Yasuda, Yoshinari, Nagoya University Graduate School of Medicine, Nagoya, Japan
  • Tsuboi, Naotake, Nagoya University Graduate School of Medicine, Nagoya, Japan
  • Maruyama, Shoichi, Nagoya University Graduate School of Medicine, Nagoya, Japan

Although Columbia classification are widely used, clinical importance of specific pathological findings in FSGS is unclear. We focused on simple attachment and findings of endothelial damage in the glomeruli on light microscopy and evaluated the association between these findings and therapeutic reactivity of adult nephrotic FSGS.


Forty-eight out of 183 biopsy-proven FSGS during 2005-2015 were included: ≥20 years old, nephrotic syndrome, received immunosuppressive therapy and whose pathological slides or paraffin blocks were available. Pathological review was done by 3 nephrologists and 1 renal pathologist. Among 11 patients who did not fit the definition of any variants in Columbia classification, cases who only have small synechia to Bowman capsule were categorized to “simple attachment” and who only have findings indicating endothelial damage i.e., mesangiolysis and/or double contour of GBM without matrix accumulation were categorized into “endothelial damage only”. Response to immunosuppressive treatment of these patients were compared with that of typical FSGS variants.


There were 16 TIP (33.3%), 17 CEL (35.4%) and 4 NOS (8.3%). None showed collapsing or perihilar variant. There were 5 “simple attachment” cases and 6 “endothelial damage only” cases. No difference was observed in the details of immunosuppressive treatment among the subgroups. Kaplan-Meier method revealed that “simple attachment” cases showed the best therapeutic response and NOS showed the worst response. And “endothelial damage only” cases showed similar response to CEL or TIP.


Synechia or findings of endothelial damage are commonly observed in FSGS on light microscopy, although they do not play key roles in diagnosis and classification of FSGS. In adult nephrotic FSGS, simple attachment indicated good therapeutic response. On the other hand, even if patients only have the findings of endothelial damage, it might be clinically equivalent to other variants of FSGS.