Question:
Loss of foot processes (foot process effacement) on electron microscopy is classical in which of the following?
Loss of foot processes (foot process effacement) on electron microscopy is classical in which of the following?
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Think of the podocyte diseases: the segmental scarring entity on the list shows effacement as its dominant EM finding.
Updated On: Jun 23, 2026
- Membranous glomerulonephritis
- Focal segmental glomerulosclerosis
- IgA nephropathy
- Diabetic nephropathy
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The Correct Option is B
Solution and Explanation
Correct answer: Focal segmental glomerulosclerosis (FSGS).
Step 1: FSGS is a major cause of nephrotic syndrome, especially in adults. Among the listed options, diffuse podocyte foot process effacement is the predominant electron-microscopy finding in FSGS, without significant basement membrane changes.
Step 2: Light microscopy shows sclerosis, hyalinosis, and adhesions causing segmental obliteration of glomerular capillaries. Immunofluorescence shows IgM and C3 trapped in the sclerotic segments. Juxtamedullary glomeruli are hit first, so a shallow biopsy can miss the focal lesions.
Step 3: Why not the others. Membranous GN shows subepithelial deposits and a thick capillary wall with spikes. IgA nephropathy shows mesangial IgA deposits. Diabetic nephropathy shows GBM thickening and Kimmelstiel-Wilson nodules. Foot process effacement is the effacement classically tied to podocyte diseases like FSGS (and minimal change disease).
Ref: NCBI Bookshelf NBK532272, FSGS.
Step 1: FSGS is a major cause of nephrotic syndrome, especially in adults. Among the listed options, diffuse podocyte foot process effacement is the predominant electron-microscopy finding in FSGS, without significant basement membrane changes.
Step 2: Light microscopy shows sclerosis, hyalinosis, and adhesions causing segmental obliteration of glomerular capillaries. Immunofluorescence shows IgM and C3 trapped in the sclerotic segments. Juxtamedullary glomeruli are hit first, so a shallow biopsy can miss the focal lesions.
Step 3: Why not the others. Membranous GN shows subepithelial deposits and a thick capillary wall with spikes. IgA nephropathy shows mesangial IgA deposits. Diabetic nephropathy shows GBM thickening and Kimmelstiel-Wilson nodules. Foot process effacement is the effacement classically tied to podocyte diseases like FSGS (and minimal change disease).
Ref: NCBI Bookshelf NBK532272, FSGS.
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