GLOMERULAR HYPERTROPHY AND CHRONIC-RENAL-FAILURE IN FOCAL SEGMENTAL GLOMERULOSCLEROSIS

Focal segmental glomerulosclerosis evolves toward chronic renal failure (CRF) with a highly variable rate; in particular, a group of patients with a much more rapid decline of renal function has been described. The purpose of this study was to evaluate the usefulness of morphometry in identifying those cases with a faster decline in renal function. Two groups of patients have been studied: six with rapid evolution toward CRF (group 1) and six without reduction in renal function during a follow-up of up to 10 years (group 2). The results of the morphometric analysis of glomeruli were as follows: mean glomerular area: 30,550 ± 5,259 µm2 (group 1) versus 22,667 ± 5,078 µm2 (group 2) (P = 0.01); maximum glomerular area: 40,827 ± 9,508 µm2 (group 1) versus 30,445 ± 7,224 µm2 (group 2) (P = 0.02); mean glomerular diameter: 193.9 ± 15.8 µm (group 1) versus 161.8 ± 16.8 µm (group 2) (P = 0.003); and caliper diameter: 328.6 ± 20.6 µm (group 1) versus 260.6 ± 36 µm (group 2) (P = 0.001). Values of body surface area were not different between the two groups (1.85 ± 0.34 µm v 1.6 ± 0.13 µm) (P = NS). Our results suggest that glomerular hypertrophy in the course of focal segmental glomerulosclerosis is correlated with a faster decline toward CRF. It might represent a compensatory hypertrophy that would immediately precede a rapid decline in renal function or it might be the expression of the preexisting condition (meganephronia), which predisposes to the development of CRF. © 1994, National Kidney Foundation. All rights reserved. All rights reserved.