Role of the Histological Variant for the Prognosis and Course of the Focal Segmental Glomerulosclerosis

The focal segmental glomerulosclerosis is characterized by a morphological heterogeneity, most likely reflecting different pathogenetic mechanisms. The Colombian classification distinguishes five morphological types – non-specific (not otherwise specified or classical), perihilar, cellular, a tubular pole (tip) one and a collapsing one. Eighty-one (81) patients were studied. Their distribution according to the histological variant showed the highest frequency of the non-specific (classical) variant – 70.4%, followed by the perihilar variant – 27.20%, the cellular variant – 1.2% and the collapsing variant – 1.2%. No patients with tip lesions were identified. There were significant differences in the creatinine levels and the glomerular filtration rate (GFR) at the beginning and at the end of the follow-up between patients with the perihilar and the non-specific variants. Patients with the perihilar variant had a better treatment response with a high percentage of patients achieving complete remission – 59.1%. Patients with the non-specific variant had a high chance of treatment failure – 26.3% had no effect from treatment. The results of the study give grounds to assume that the histological variant affects the clinical picture, course and therapeutic response in patients with focal segmental glomerulosclerosis. It could be used as a prognostic marker of disease behavior and guide the clinician in treatment decisions.