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FSGS Columbia Variant Prognosis — ESENeph MCQ

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ModerateGlomerulonephritisFSGS Columbia Variant PrognosisESENeph

A 45-year-old woman with biopsy-confirmed focal segmental glomerulosclerosis asks about the different histological variants. Her biopsy shows the tip variant. Which variant has the best prognosis?

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Correct answer: C — The tip variant of FSGS has the best prognosis and highest steroid responsiveness; the collapsing variant has the worst prognosis; NOS (not otherwise specified) is intermediate; perihilar suggests adaptive/secondary FSGS; cellular variant has intermediate prognosis

The Columbia classification of FSGS recognises 5 histological variants with different prognoses: (1) Tip variant – best prognosis, highest steroid response rate (~80%), often presents with sudden-onset nephrotic syndrome; (2) Cellular variant – intermediate, may respond to steroids; (3) NOS (not otherwise specified) – most common, intermediate prognosis; (4) Perihilar variant – suggests adaptive/secondary FSGS (from hyperfiltration, obesity, reduced nephron mass) – does not respond to immunosuppression; (5) Collapsing variant – worst prognosis, associated with HIVAN, APOL1, and COVID-19, often steroid-resistant. Identifying the variant guides treatment expectations.

Reference: KDIGO 2021 – GN; Thomas et al 2006 – Columbia FSGS Classification