The significance of focal and segmental hyalinosis and sclerosis (FSHS) and nephrotic range proteinuria in IgA nephropathy

Clin Nephrol. 1996 Oct;46(4):225-9.


Between 1971 and 1991, 845 patients were diagnosed as having IgA glomerulonephritis on renal biopsy performed. These patients were followed for a mean period of 53 months post biopsy (range 0-336 months). By the end of follow up 147 (17%) of patients have developed chronic renal failure (Cr > 0.2 mmol/l) or end-stage renal failure. Presenting creatinine > 0.12 mmol/l, hypertension, nephrotic range, age > 40 years and male gender, all correlated strongly on univariate analysis with the development of chronic renal failure or kidney disease (all p < 0.0001). However, a number of patients developing chronic renal failure or end-stage renal failure already had renal impairment (creatinine > 0.12 mmol/l at presentation). A separate comparison was performed of patients presenting with creatinine < 0.12 mmol/l and either developing chronic failure or end-stage renal failure within 5 years of biopsy (n = 18) and those with creatinine still < 0.12 mmol/l after 5 years follow up (n = 186). Of the 18 patients who deteriorated 6 (35%) were nephrotic at presentation and 9 (56%) had focal hyalinosis and sclerosis on renal biopsy. This compared with 5 (3%) patients with nephrotic range proteinuria and 16 (10%) patients with focal hyalinosis and sclerosis among the 186 patients who did not deteriorate (p < 0.0001). The sensitivity and specificity of the presence of either or both factors in predicting deterioration was calculated at 65% and 87% respectively. Thus in patients with normal renal function at presentation the presence of nephrotic range or focal hyalinosis and sclerosis are strong predictors of adverse clinical outcome.

MeSH terms

  • Adult
  • Biopsy
  • Case-Control Studies
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Glomerulonephritis, IGA / diagnosis*
  • Glomerulonephritis, IGA / epidemiology
  • Glomerulonephritis, IGA / urine
  • Glomerulosclerosis, Focal Segmental / epidemiology*
  • Glomerulosclerosis, Focal Segmental / pathology
  • Humans
  • Kidney Failure, Chronic / epidemiology
  • Kidney Glomerulus / pathology*
  • Male
  • Predictive Value of Tests
  • Proteinuria / epidemiology*
  • Proteinuria / pathology
  • Risk Factors
  • Sensitivity and Specificity
  • Time Factors