Hepatic Glomerulosclerosis
Robert B. Colvin, MD
Key Facts
Terminology
Glomerular disease caused by portal hypertension
Clinical Issues
Present in ˜ 60% of cirrhotics
Asymptomatic hematuria, proteinuria
Remission with correction of portal hypertension
Microscopic Pathology
Glomeruli usually show mild mesangial expansion
Other patterns: MPGN type I, normal
Ancillary Tests
Mesangial deposits
Prominent IgA; lesser IgG, IgM, C3; often C1q
Electron-dense lipid granules, lucencies
Amorphous electron-dense deposits
Top Differential Diagnoses
IgA nephropathy; MPGN, type I; HCV glomerulonephritis
 Hepatic glomerulosclerosis (HGS) characteristically has lipid debris in the mesangium  , evident by electron microscopy. Amorphous electron-dense deposits typical of immune complexes are also present  . |
 By immunofluorescence, prominent IgA deposits are present in the expanded mesangium in HGS. The pattern resembles IgA nephropathy although inflammatory changes are absent. |
TERMINOLOGY
Abbreviations
Hepatic glomerulosclerosis (HGS)
Synonyms
Cirrhotic glomerulosclerosis
Definitions
Glomerular disease related to cirrhosis or portal hypertension, manifested by accumulation of IgA and lipid debris in mesangium; excludes HCV immune complex diseases
ETIOLOGY/PATHOGENESIS
Failure of Normal Liver Clearance Mechanisms
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