title: Tip variant of focal segmental glomerulosclerosis: is it truly a benign variant?
abstract: BACKGROUND
  Even though frequently described as a benign entity, the outcomes of the tip variant of focal segmental glomerulosclerosis (FSGS) have proven to be unclear.
  
  
  METHODS
  This retrospective study includes a cohort of tip variant cases who presented to us from 2009 to 2012 and the analysis of their presenting clinical, histopathological features and treatment outcomes in comparison to the not otherwise specified (NOS) variants from our center in East India.
  
  
  RESULTS
  Of the 224 biopsies of primary FSGS, 30 cases were the tip variant (13.39%). The mean age of presentation was around 29 years, with 57% being males. A nephrotic presentation was seen in 87% of cases, with 20% showing a presentation at <18 years of age for the first time. Global sclerosis, interstitial fibrosis, tubular atrophy and arteriolar hyalinosis were seen more commonly in the NOS variant. Twenty five patients of tip variant received steroid therapy and eight received alternative immunosuppression. Around 87% of the tip variant cases achieved some form of remission in proteinuria and 13.3% had a doubling of creatinine at a median follow-up of 2 years in comparison to NOS group in which 80% achieved some form of remission and 20% had a doubling of creatinine.
  
  
  CONCLUSIONS
  Though the histopathological features and treatment responsiveness of the tip variant appear to be better than the NOS variety, the prognostic outcome does not seem to be as favorable as implicated previously with an important percentage of patients showing progressive worsening of renal function within a relatively short time span (2 years) in our cohort.
authors.affiliation: a Department of Nephrology , Institute of Postgraduate Medical Education and Research , Kolkata , India and.
authors.forename: Mayuri
authors.initials: M
authors.lastname: Trivedi
authors.forename: Amit
authors.initials: A
authors.lastname: Pasari
authors.forename: Arpita Roy
authors.initials: AR
authors.lastname: Chowdhury
authors.forename: Anila
authors.initials: A
authors.lastname: Abraham
authors.forename: Rajendra
authors.initials: R
authors.lastname: Pandey
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D003404:Creatinine / Q000032:analysis*; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000473:pathology*; D006801:Humans; D007165:Immunosuppression Therapy; D007194:India; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011507:Proteinuria / Q000453:epidemiology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003404:Creatinine
keywords: Focal segmental glomerulosclerosis; India; NOS variant; nephrotic syndrome; tip variant