Background: The lesions resembling focal segmental glomerulosclerosis (FSGS) are frequently found concurrently with IgA nephropathy (IgAN). However, there is controversy regarding the significance of this co -existence. In this study, we sought to determine the significance of FSGS-like lesions in a group of IgAN patients, especially with regard to the Oxford classification. Patients and Methods: The FSGS lesions were typed according to the Columbia classification and correlated with clinico -pathological parameters including Oxford classification criteria. Individual lesions suggesting FSGS were also evaluated. IgAN lesions were classified according to the Oxford classification. Results: Of 114 patients, 80 (70.2 %) were male. The mean age of patients was 37.7 �± 13.6 years. Of 35 patients with co-existent IgAN and FSGS, 50% had classic variant (not otherwise specified; NOS), 30% had tip and 20% perihilar variant of FSGS. None of the patients had collapsing or cellular variants. A significantly positive association of FSGS with M (p = 0.001), S (p = 0.001) and T p = 0.001) variables of Oxford classification was found. No significant difference of FSGS, hyalinosis, capsular adhesions and podocytopathy was found between males and females (p > 0.05). However, a significantly positive association of proteinuria (p = 0.037) and renal dysfunction (p = 0.026) with podocytopathy, and of serum creatinine and renal dysfunction with the presence of FSGS (p = 0.027, p = 0.001, respectively) was seen. Conclusion: In conclusion, the concurrence of FSGS -like lesions with IgAN is associated with the established poor clinical and pathological prognostic factors of this disease and the lesions appear to be of prognostic significance. The presence of such lesions should be sought diligently on renal biopsy examination.

O estágio terminal de suficiência renal freqüentemente está associado a sangramentos anormais e que representam complicações importantes na evolução desta moléstia. A tendência hemorrágica é atribuída a alterações primárias de hemostasia, decorrentes principalmente da disfunção plaquetária. O objetivo deste estudo foi o de elucidar quando como pacientes urêmicos, em hemodiálise o nível de HCO3 afeta a contagem plaquetária e o seu volume médio. O número de pacientes estudados foi 36 (fem.15, masc. = 21). A idade foi de 46 ± 16 anos. A contagem média das plaquetas foi de 165(± 70) x 10³mi/l, o volume médio foi de 9 (± 1) fl. O HCO3 plasmático médio foi de 20 (± 2,6) mEq/l. No estudo foi observada uma correlação inversa entre a contagem plaquetária e o volume médio associado com associação positiva significante das plaquetas com o HCO3 do plasma e também correlação significativa inversa do volume médio plaquetário e HCO3 plasma. A associação positiva e sua correlação negativa com o volume médio plaquetário podem sugerir reversão da epidemiologia do estágio terminal de insuficiência renal de pacientes em hemodiálise que necessitam de maior proteção quando da acidose leve em vigência de hemodiálise.

End-stage renal failure often is associated with abnormal bleeding that may represent an important complication of this disorder. The hemorrhagic tendency currently is attributed to altered primary hemostasis, mainly platelet dysfunction. The aim of the present study was to elucidate whether and how in patients, with uremia on hemodialysis, the level of plasma HCO3- affects the mean PLT volume (MPV) and count. The total patients were 36 (f=15, m=21). The mean patients' age was 46 (±16) years. The mean length of the time patients had received hemodialysis was 32 (±36) months. The mean PLT count was 165 (±70) [x10³mu/L]. The mean MPV was 9 (±1) fl. The mean plasma HCO3- was 20 (±2.6) mEq/L. In this study a significant inverse correlation of PLT count with MPV and a significant positive association of PLT count with plasma HCO3 and also a significant inverse correlation of MPV with plasma HCO3- were found. Positive association of mild relative acidemia with PLT count and its negative correlation with MPV may further support the reverse epidemiology of serum bicarbonate in end-stage renal disease patients on hemodialysis which needs more attention as a protective role in mild relative acidosis of regular hemodialysis patients.