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• W2034408404 abstract "To the Editor: The term “glomerular tip lesion”1Stokes M.B. Markowitz G.S. Lin A. et al.Glomerular tip lesion: A distinct entity within the minimal change disease/focal segmental glomerulosclerosis spectrum.Kidney Int. 2004; 65: 1690-1702Abstract Full Text Full Text PDF PubMed Scopus (90) Google Scholar has been used with three meanings: (1) Our original description was in nephrotic patients with structural changes at the tubular origin in glomeruli that were otherwise normal. The clinical course resembled that of minimal change nephropathy2Howie A.J. Brewer D.B. The glomerular tip lesion: A previously undescribed type of segmental glomerular abnormality.J Pathol. 1984; 142: 205-220Crossref PubMed Scopus (97) Google Scholar. (2) We later realized that such changes were a common finding in many disorders, such as membranous nephropathy3Howie A.J. Changes at the glomerular tip: A feature of membranous nephropathy and other disorders associated with proteinuria.J Pathol. 1986; 150: 13-20Crossref PubMed Scopus (54) Google Scholar. These tip changes were not themselves a disease, but could only be interpreted by consideration of the rest of the glomerulus. Others have applied the term “glomerular tip lesion” to these changes, irrespective of the associated condition. (3) We also reported tip changes in glomeruli showing mesangial hypercellularity in the nephrotic syndrome, sometimes with clinical progression3Howie A.J. Changes at the glomerular tip: A feature of membranous nephropathy and other disorders associated with proteinuria.J Pathol. 1986; 150: 13-20Crossref PubMed Scopus (54) Google Scholar,4Howie A.J. Lee S.J. Green N.J. et al.Different clinicopathological types of segmental sclerosing glomerular lesions in adults.Nephrol Dial Transplant. 1993; 8: 590-599PubMed Google Scholar. The ones who did badly developed segmental sclerosis, corresponding to many descriptions of “focal segmental glomerulosclerosis.” We called the early stage early classical focal segmental glomerulosclerosis4Howie A.J. Lee S.J. Green N.J. et al.Different clinicopathological types of segmental sclerosing glomerular lesions in adults.Nephrol Dial Transplant. 1993; 8: 590-599PubMed Google Scholar. ‘Glomerular tip lesion,’ as defined by D'Agati et al1Stokes M.B. Markowitz G.S. Lin A. et al.Glomerular tip lesion: A distinct entity within the minimal change disease/focal segmental glomerulosclerosis spectrum.Kidney Int. 2004; 65: 1690-1702Abstract Full Text Full Text PDF PubMed Scopus (90) Google Scholar, also called “the tip variant of focal segmental glomerulosclerosis,” clearly includes our original definition, and excludes tip changes in conditions such as membranous nephropathy. Their definition allows mesangial hypercellularity, and some of their patients may correspond to early classical focal segmental glomerulosclerosis. Differentiation between normal mesangium and mild mesangial hypercellularity is arbitrary, but at the moment there is no other satisfactory test to identify those who may progress. We agree with D'Agati et al that most patients with the “glomerular tip lesion” by their definition, have steroid responsive nephrotic syndrome and a good prognosis." @default.
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• W2034408404 title "Different meanings of “glomerular tip lesion”" @default.
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• W2034408404 doi "https://doi.org/10.1111/j.1523-1755.2004.938_10.x" @default.
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