Focal and segmental glomerulosclerosis in renal allograft recipients: a clinico-pathologic study of 37 cases

Focal and segmental glomerulosclerosis (FSGS) in renal allografts may occur as a recurrence of primary FSGS,as a de novo phenomenon or as a complication of calcineurin inhibitor toxicity. There are very few studies in the literature describing the clinico-pathologic characteristics of FSGS in renal allografts. To the best of our knowledge,no such study exists from the Indian subcontinent. Thirty-seven cases showing FSGS,of 426 transplant biopsies performed over a 4-year period (2006-2009),were included in this study. The pre- and post-transplant clinical data were noted. FSGS was classified as per the Columbia scheme. Appropriate statistical tests were applied. The age of the study patients ranged from 13 to 54 years,with a male preponderance. Thirty-five patients (94.6%) were diagnosed as FSGS more than 12 months after transplantation. All the patients presented with renal dysfunction (median serum creatinine 2.8 mg/dL) and detectable proteinuria at the time of diagnosis. Histologically,FSGS-NOS (70.3%) was observed as the most common subtype,followed by collapsing and perihilar varieties (13.5% each). Most of the biopsies (83.7%) showed grade-2 to -3 interstitial fibrosis and tubular atrophy. Follow-up data were available in 27 patients (73%),of whom 12 (44.4%) had graft loss with dialysis-dependent state at last follow-up. FSGS is one of the important causes of graft dysfunction,especially late in the post-transplantation period in cases of de novo FSGS. The long-term outcome of renal allografts developing this glomerular pathology is quite dismal,with a significant proportion of patients suffering graft loss.