Saudi Journal of Kidney Diseases and Transplantation

: 2013  |  Volume : 24  |  Issue : 4  |  Page : 823--824

Authors' reply

Amit K Dinda 
 Professor, Department of Pathology, All India Institute of Medical Sciences, New Delhi - 110 029, India

Correspondence Address:
Amit K Dinda
Professor, Department of Pathology, All India Institute of Medical Sciences, New Delhi - 110 029

How to cite this article:
Dinda AK. Authors' reply.Saudi J Kidney Dis Transpl 2013;24:823-824

How to cite this URL:
Dinda AK. Authors' reply. Saudi J Kidney Dis Transpl [serial online] 2013 [cited 2021 Jun 17 ];24:823-824
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Full Text

To the Editor,

I am enclosing my response to the Letter to Editor point-wise as follows:

Routinely, we examine 3-micron-thick paraffin sections and examine more than 15 serial step sections in each case. For critical morphological diagnosis of FSGS, we try to follow each glomerulus in serial step sections.In all pediatric cases, the biopsy is performed after initial adequate steroid therapy in our center. The adult cases presented as nephrotic syndrome are biopsied first before immunosuppressive therapy. Many of the cases in the current series were biopsied after steroid trial and were not out of immunosuppression for a long interval. Therefore, we did not wait for the proteinuria to attain nephrotic range again before performing biopsy. That might be the cause of sub-nephrotic range proteinuria in some cases. However, the pediatric nephrology group in our center strictly follows the criteria of diagnosing nephrotic syndrome during initial presentation of the case before starting the steroid therapy.We agree that we obtained a higher incidence of perihilar FSGS in our series; we followed the criteria of >50% perihilar location of segmental sclerosis for diagnosing this sub-type.We saw an increase in the visceral epithelial cells in some cases on light microscopy that are not usually seen in a majority of FSGS. We did not apply strict quantitative criteria.I agree that this study would have a lot of translational potential if we could have the follow-up data of these cases.We reviewed many articles applying the Columbia Classification and, in the majority of them, endocapillary hypercellularity was considered as the feature of cellular variant (e.g., Taneda S et al, Int Urol Nephrol 2012; 44(1):183-96).