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Epidemiology, classification, and pathogenesis of focal segmental glomerulosclerosis

Jochen Reiser, MD, PhD
Section Editors
Richard J Glassock, MD, MACP
Fernando C Fervenza, MD, PhD
Deputy Editor
Albert Q Lam, MD


Focal segmental glomerulosclerosis (FSGS) is a histologic lesion, rather than a disease, that is commonly found to underlie the nephrotic syndrome in adults and children, particularly in the United States, Brazil, and many other countries [1-6].

The focal nature of the glomerulosclerosis means that some mild cases of FSGS will be missed on renal biopsy due to sampling error and will be misclassified as minimal change disease. (See "Etiology, clinical features, and diagnosis of minimal change disease in adults", section on 'Primary MCD versus primary FSGS'.)

The epidemiology, classification, and pathogenesis of FSGS will be reviewed in this topic. The treatment of both primary FSGS and recurrent disease in the renal transplant are discussed separately. (See "Treatment of primary focal segmental glomerulosclerosis" and "Focal segmental glomerulosclerosis in the transplanted kidney".)


A survey of renal biopsies performed in the United States from 1995 to 1997 for idiopathic nephrotic syndrome in adults found that focal segmental glomerulosclerosis (FSGS) was the most common lesion seen, accounting for 35 percent of all cases and over 50 percent of cases among blacks [1]. (See 'FSGS in African Americans' below.)

According to data from the United States Renal Data System (USRDS) collected over 21 years, FSGS is the most common pathology identified in patients with end-stage renal disease (ESRD) in the United States [3]. The prevalence of FSGS as a lesion associated with ESRD has risen. In 1980, FSGS was the cause of ESRD in only 0.2 percent of patients; by 2000, it was responsible for 2.3 percent of cases (excluding patients with HIV), an 11-fold increase. The risk of ESRD was fourfold higher in black patients compared with white and Asian patients and 1.5- to twofold higher in males compared with females.


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