Is focal segmental glomerulosclerosis really focal? Distribution of lesions in adults and children.

The distribution of lesions of glomerulosclerosis, whether focal or diffuse, has important implications for pathogenesis and potential therapeutic response. Determination of focal or diffuse nature of lesions from a single section, may, however, be misleading. We therefore evaluated the distribution of segmental glomerulosclerosis in patients with nephrotic syndrome and idiopathic focal segmental glomerulosclerosis (FSGS) by three-dimensional analysis. From our files, we identified all such biopsies with a diagnosis established by immunofluorescence, electron microscopy, and light microscopy that had > 10 glomeruli and serum creatine < 3.5 g/dl. Renal biopsies from 15 adults (9 women, 6 men, age 40.3 +/- 4.2 years and six children (2 girls, 4 boys, age 6.3 +/- 1.4 years) thus identified had sufficient serial sections for analysis. An average of 20.0 +/- 2.6 glomeruli in adults versus 25.2 +/- 3.9 in children were examined. Sclerosis assessed on a single section involved 31.5 +/- 6.8% of glomeruli in adults, contrasting only 11.7 +/- 5.7% in children (P < 0.05). Complete serial section analysis was possible in 14.1 +/- 1.6 and 10.7 +/- 1.6 glomeruli in adults and children, respectively. After this serial section analysis, the percent of glomeruli involved by sclerosis increased to 48.0 +/- 6.6% in adults and 23.2 +/- 7.4% in children (P < 0.025). The pattern remained focal in all but one case that had the highest serum creatinine. The greater increase in sclerosis after serial section analysis in children versus adults reflects the predominance of small peripheral, that is, more segmental, lesions in children than adults.(ABSTRACT TRUNCATED AT 250 WORDS)

Developmental outcome of infants with grade III intraventricular hemorrhage.

To determine the developmental outcome of premature infants weighing 1,750 gm or less at birth and who had grade III intraventricular hemorrhage (IVH), we followed up ten infants with IVH confirmed by computed tomography (CT) and ten CT-negative control infants until they were 12 months corrected age. The infants were evaluated at three-month intervals with neurologic examinations; hearing, speech, and language assessments; Bayley testing; and evoked response studies. Normal criteria were defined in each area. Eight of the ten grade III IVH survivors had identifiable defects, with a predominance of motor deficits, as assessed by two or more parameters. Only three of the ten patients without IVH had two or more suspicious or abnormal assessments. Infants with grade III IVH may have widespread damage. A multidisciplinary approach to evaluating these patients is mandatory to determine the full extent of various deficits. Similar studies of infants with all degrees of IVH may help to define its full impact on their long-term development.