Podocyte detachment and epithelial cell reaction in focal segmental glomerulosclerosis with cellular variants

In primary focal segmental glomerulosclerosis with cellular variants the type of epithelial cells that segmentally or globally increased and their relation to sites where podocytes detached from the capillary wall, remain unclear. Two renal samples containing glomeruli with cellular variants were serially examined using transmission electron microscopy. A total of 10 lesions, including 2 collapsing glomerulopathy, 7 cellular lesions, and 1 sclerosis, were examined. Disappearance of the dense basal band of microfilaments from portions of podocytes was followed by detachment from the capillary basement membrane, resulting in segmental denudation of the capillary wall. The defects were not covered by other portions of epithelial cells, when the defects occurred in more central regions of the glomerulus. When detachment of podocytes occurred in the peripheral areas of the glomerulus, the defects were covered with new basement membrane and by other epithelial cells. These epithelial cells were characterized by the formation of intercellular junctional complexes of zonula adherens and desmosomes between each other and with the parietal epithelial cells (PECs), by showing occasional cilia, apoptotic nuclei, and mitosis. Thus, repair is achieved as the defect is covered by the participation of PECs; synechia and glomerular sclerosis result, depending upon the extent of the original podocyte injury.