A 35-year-old HIV-positive man presents with nephrotic-range proteinuria and progressive renal failure. Biopsy shows segmental glomerulosclerosis with collapse of glomerular capillaries and prominent podocyte hypertrophy and hyperplasia. The pattern is best described as:
- A Classic (NOS) FSGS
- B Tip lesion FSGS
- C Collapsing FSGS (HIV nephropathy) ✓
- D Perihilar FSGS
Correct answer: C. Collapsing FSGS (HIV nephropathy)
Explanation
HIV-associated nephropathy (HIVAN) classically presents as collapsing FSGS, characterized by collapse of the glomerular tuft, hypertrophied/hyperplastic podocytes, and microcystic tubular dilation. It progresses rapidly to end-stage renal disease. The tip lesion variant has a favorable prognosis and responds to steroids; perihilar FSGS is associated with hyperfiltration states; classic NOS FSGS is the most common variant but lacks the collapsing feature.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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