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Published on: July 14, 2016
Secondary focal and segmental glomerulosclerosis associated with single-nucleotide polymorphisms in the genes
Sanjeev Sethi1, Fernando C Fervenza, Yuzhou Zhang
1Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA. sethi.sanjeev@mayo.edu
Genetic kidney disease, focal and segmental glomerulosclerosis (FSGS), can be linked to complement factor abnormalities. This study identifies new genetic variants in complement factor H and C3 associated with FSGS.
Area of Science:
- Nephrology
- Genetics
- Immunology
Background:
- Focal and segmental glomerulosclerosis (FSGS) is a leading cause of kidney disease, often linked to genetic factors affecting podocytes or glomerular basement membranes.
- While complement-mediated glomerular diseases are known, their association with FSGS, particularly with capillary wall injury features, is less understood.
Observation:
- A 60-year-old woman with chronic kidney disease presented with FSGS on biopsy, showing no immunoglobulin or C3 deposits.
- Electron microscopy revealed subendothelial granular material and double-contour formation, suggesting capillary wall injury and prompting investigation into prothrombotic states.
Findings:
- Genetic analysis revealed a novel polymorphism in complement factor H (CFH; c.2195C>T, p.Thr732Met) and a known polymorphism in complement factor C3 (c.463A>C, p.Lys155Gln).
- These polymorphisms suggest dysregulation of the alternative complement pathway, previously unassociated with FSGS.
Implications:
- This case expands the known spectrum of complement-mediated glomerular diseases to include FSGS with capillary wall injury.
- It highlights the importance of evaluating the alternative complement pathway in FSGS cases with specific ultrastructural findings.
- The study broadens the list of genetic polymorphisms associated with an FSGS phenotype, aiding in diagnosis and understanding disease mechanisms.
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