Application of the Columbia Classification of Focal Segmental Glomerulosclerosis in Kidney Biopsies from Patients with HIV Infection.
Shane M Meehan, Lisa Kim, Anthony Chang. University of Chicago, IL
Background: The Columbia system of classification of focal segmental glomerulosclerosis (FSGS) identifies 5 different types or variants of this distinct glomerular lesion. FSGS of the collapsing variant is a classical feature of HIV associated nephropathy. Other variants of FSGS have also been described in this disorder. We examined the spectrum of FSGS lesions in biopsies obtained from patients with HIV infection using the Columbia classification system.
Design: We identified 43 renal biopsies from 42 patients with HIV infection obtained over a 7 year period. Twenty five biopsies had FSGS. Reproducibility of the Columbia system was good (kappa 0.65).
Results: Sixteen biopsies had FSGS, collapsing variant (coll) (64%). Six had FSGS not otherwise specified (NOS) (24%). Fifteen biopsies (60%) had focal glomerular capillary collapse without visceral epithelial hyperplasia (10 coll, 4 NOS, 1 cell). One each had cellular (cell), tip lesion (T) and perihilar (Ph) variants. Glomeruli with features of multiple variants of FSGS were frequently identified in the same biopsy and included coll with NOS (n=9), cell (n=5), or Ph (n=3), cell and NOS (n=1), T and NOS (n=1).
Conclusions: It is no surprise that collapsing FSGS was the commonest variant observed in biopsies from HIV infected patients. NOS lesions were less common and other variants rare. Mixed Columbia FSGS lesions were evident in more than half of this sample (52%). Mixed patterns of FSGS raise the possibility that Columbia FSGS variant lesions may form part of a spectrum of glomerular responses to injury in HIV infection.
Category: Kidney (does not include tumors)
Wednesday, March 2, 2011 1:00 PM
Poster Session VI # 238, Wednesday Afternoon