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. 2021 May 20;17(9):619–630. doi: 10.1038/s41581-021-00427-1

Fig. 4. FSGS findings by light microscopy.

Fig. 4

A 41-year-old man with a history of sickle cell disease presented with shortness of breath, pleural effusions and lower extremity oedema. His weight was 120.7 kg, serum creatinine 177 µmol/l (2 mg/dl), serum albumin 34 g/l (3.4 g/dl), proteinuria 12 g/24 h. Serology for hepatitis and HIV were negative. Light microscopy of kidney biopsy showed perihilar (a), tip (b), not otherwise specified (NOS) (c) and (d) collapsing lesions. a,b: silver methenamine stain, c,d: periodic acid Schiff stain; magnification ×40. Black arrows show areas of segmental sclerosis; green arrows show a collapsing lesion with epithelial cell hypertrophy and protein reabsorption granules within the epithelial cells. The presence of different Columbia classification subtypes in a single biopsy underlines the inability of light microscopy alone to classify a focal segmental glomerulosclerosis lesion aetiologically. Electron microscopy showed diffuse foot process effacement. The diagnosis of presumed permeability factor focal segmental glomerulosclerosis was made.