What is your diagnosis?
The photomicrograph is a high power PAS-stained section showing a glomerulus with focal segmental glomerulosclerosis, tip-lesion type. At 10 o’clock you can see a capillary loop becoming adherent to the take-off of the proximal tubule which also shows endocapillary foam cell formation and extracapillary protein resorption droplets. While the findings in this case are a bit more subtle than some, these are classic findings for focal segmental glomerulosclerosis, tip lesion type.
This patient presented with abrupt onset of nephrotic syndrome and nephrotic range proteinuria with no significant past history of kidney disease. Clinically, focal segmental glomerulosclerosis, tip lesion type has the most favorable prognosis of all forms of focal segmental glomerulosclerosis and is frequently corticosteroid responsive.
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