American Board of Internal Medicine (ABIM) Certification Practice Exam

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What is a hallmark feature of focal segmental glomerulosclerosis (FSGS)?

  1. Global sclerosis in all glomeruli

  2. Segmental scars in some glomeruli

  3. Presence of immune deposits

  4. Normal foot process appearance

The correct answer is: Segmental scars in some glomeruli

Focal segmental glomerulosclerosis (FSGS) is characterized by the presence of segmental scarring which affects some of the glomeruli within the kidney. This means that only specific areas of the glomeruli show damage or sclerosis—hence the term "segmental"—and not all glomeruli are involved, which aligns with the "focal" aspect of the condition. This feature distinguishes FSGS from other glomerular diseases. For instance, global sclerosis affecting all glomeruli is a hallmark of different conditions, such as diffuse glomerulosclerosis. The presence of immune deposits is more characteristic of other types of glomerulonephritis, such as membranous nephropathy or lupus nephritis. Lastly, in FSGS, the foot processes of podocytes are typically altered, exhibiting effacement rather than appearing normal. Thus, segmental scars in some glomeruli accurately reflects a key pathological finding in FSGS, making it the correct choice.

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