title: Overdiagnosis: under-recognized clinical and pathological features of "focal ischemic glomerulosclerosis clustering".
abstract: "Focal ischemic glomerulosclerosis clustering (FIGSC)" is a term used by us temporarily to describe a rare kind of focal renal scar with a high percentage of global sclerosis in the renal biopsy tissue. We retrospectively studied the clinical and pathological data from 15 cases of FIGSC followed up in order to avoid overdiagnosis and to investigate its diagnostic basis. We found that in 7 cases with FIGSC, the percentage of global sclerosis was higher than 50% with mild or moderate tubulointerstitial lesions, and most cases showed sclerotic regions distributed both beneath the renal capsule and in the deep cortex. Fourteen cases of afferent arterioles sclerosis were observed. Fourteen did not evolve to end-stage renal disease (ESRD) during the follow-up period. The values of the percentage of severe tubulointerstitial lesion, SCr, BUN, and the cumulative incidence of ESRD were significantly lower compared to the diffuse proliferative sclerosis glomerulonephritis group (P<0.05). The results suggest that the essence of FIGSC may be a kind of focal renal scar related to sclerosis, stenosis or obstruction of several adjacent afferent arterioles, not caused by original glomerulonephritis. Comprehensive understanding should be very important to avoid overdiagnosis and overtreatment.
authors.affiliation: Department of Pathology, Dongfang Hospital, Fuzhou 350025, China; Department of Pathology, Binzhou Medical University, Binzhou 256603, China.
authors.forename: Mingfeng
authors.initials: M
authors.lastname: Zhao
authors.affiliation: Department of Pathology, The Second Hospital of Xiamen, Xiamen 361021, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Zhang
authors.affiliation: Department of Pathology, Dongfang Hospital, Fuzhou 350025, China.
authors.forename: Feilai
authors.initials: F
authors.lastname: Xie
authors.affiliation: Department of Nephrology, Dongfang Hospital, Fuzhou 350025, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Zheng
authors.affiliation: Department of Nephrology, Dongfang Hospital, Fuzhou 350025, China.
authors.forename: Liping
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Ultrasound, Dongfang Hospital, Fuzhou 350025, China.
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Luo
authors.affiliation: Department of Pathology, Dongfang Hospital, Fuzhou 350025, China. Electronic address: FZGH2012@hotmail.com.
authors.forename: Zhiyong
authors.initials: Z
authors.lastname: Zheng
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: Arteriole sclerosis; Clinical and pathological features; Focal ischemic glomerulosclerosis; Overdiagnosis