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FSGS Tip Variant Favourable Prognosis — ESENeph MCQ

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ModerateGlomerulonephritisFSGS Tip Variant Favourable PrognosisESENeph

A 35-year-old man presents with nephrotic syndrome. Renal biopsy shows focal segmental glomerulosclerosis (FSGS) — tip variant. His eGFR is 78 mL/min/1.73m2. He is started on prednisolone 1 mg/kg/day. After 8 weeks, proteinuria has reduced by 70%. What does the tip variant predict compared to other FSGS variants?

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Correct answer: C — Better steroid responsiveness and more favourable prognosis

The Columbia classification identifies five histological variants of FSGS: tip, cellular, perihilar, collapsing, and not otherwise specified (NOS). The tip variant has the best prognosis, with higher rates of steroid responsiveness, complete remission, and long-term renal survival. The collapsing variant has the worst prognosis, with rapid progression to ESKD and poor response to therapy. The cellular variant has intermediate responsiveness. Understanding variant-specific prognosis helps guide treatment intensity and patient counselling.

Reference: D'Agati et al 2004 – Columbia Classification FSGS; KDIGO 2021 – Glomerular Diseases