[The pathogenesis of focal sclerosis ]

The authors present a synthesis of their clinicopathological and experimental research on focal and segmental glomerular hyalinosis and sclerosis. Rather than a separate entity, it should be viewed as a sequel of different nephropathies: nephrotic syndrome with minimal changes, heroin-nephropathy, membranous glomerulopathy, reflux nephropathy, etc., resulting more frequently in renal insufficiency. Glomerular sclerosis could be induced by the captation of serum lipids by the mesangium cells. And the localisation of the lesions is probably the consequence of the hemodynamic burden of some glomeruli. A better understanding of these risk factors should stimulate clinical research to find ways by which the negative effects of protein-loss and increased haemodynamic burden on remaining glomeruli can be improved.