In focal segmental glomerulosclerosis (FSGS), the Columbia classification recognizes five histological variants. Which variant carries the worst prognosis and highest risk of progression to ESRD?

• A Collapsing variant ✓
• B NOS (not otherwise specified) variant
• C Tip variant
• D Cellular variant

Explanation

The Columbia classification of FSGS includes: NOS (most common), tip, perihilar, cellular, and collapsing variants. The collapsing variant carries the worst prognosis — it is characterized by collapse and wrinkling of the glomerular tuft with overlying podocyte hypertrophy and hyperplasia (pseudocrescent formation). It is associated with HIV nephropathy, parvovirus B19, pamidronate nephrotoxicity, and certain genetic variants (APOL1 risk alleles in individuals of West African ancestry). The collapsing variant progresses most rapidly to ESRD. The tip variant has the best prognosis (often steroid-responsive) because the lesion is at the tubular pole with preserved glomerular architecture elsewhere.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.