Clinicopathological Characteristics of Children with Focal Segmental Glomerulosclerosis

Open Access

Abstract

Background: Focal segmental glomerulosclerosis (FSGS) is a major cause of childhood nephrotic syndrome, particularly steroid-resistant nephrotic syndrome (SRNS), and is associated with variable treatment response, chronic renal damage, and disease progression. Aim: To evaluate the clinicopathological characteristics of children with biopsy-confirmed FSGS, including clinical features, treatment patterns, renal biopsy findings, and IgM/C3 deposition. Methods & Materials: This retrospective observational study was conducted in the Department of Pediatric Nephrology, Bangladesh Medical University, Dhaka, from January to December 2025. Thirty-three children with biopsy-confirmed FSGS and complete clinical, treatment, histopathological, and immunofluorescence records were included. Data were collected from hospital records using a structured sheet and analyzed with SPSS version 26.0. Quantitative data were expressed as mean ± SD or median (IQR), and qualitative data as frequencies and percentages. Results: Among 33 children, the mean current age was 8.77 ± 4.33 years, with male predominance (21; 63.6%). SRNS was the most common clinical diagnosis (19; 57.6%). At presentation, hematuria occurred in 25 (75.8%) children, hypertension in 20 (60.6%), and nephrotic-range proteinuria in 13 (39.4%). The most frequent sequential non-steroidal immunosuppressive regimen was MMF → CNI → RTX (7; 21.2%). Treatment-related complications included hypertension (26; 78.8%), hypertrichosis (23; 69.7%), and acute kidney injury (14; 42.4%). Renal biopsy commonly showed interstitial fibrosis (23; 69.7%), enlarged glomeruli (20; 60.6%), and tubular atrophy (16; 48.5%). Immunofluorescence demonstrated IgM and/or C3 positivity in 15 (45.5%) children, with no significant clinicopathological differences compared with other/negative IF groups. Conclusion: Childhood FSGS was commonly associated with SRNS, male predominance, hematuria, hypertension, and chronic biopsy changes. IgM and/or C3 deposition showed no significant clinicopathological association. Frequent treatment-related complications emphasize the need for early diagnosis, careful immunosuppressive therapy, regular monitoring, and long-term follow-up.