A spectrum of morphologic lesions of focal segmental glomerulosclerosis by Columbia criteria in human immunodeficiency virus infection

The Columbia working classification of focal segmental glomerulosclerosis (FSGS) identifies five types of glomerular lesions, designated collapsing (COLL), cellular (CELL), glomerular tip lesion (GTL), perihilar (PH), and not otherwise specified (NOS) variant lesions. FSGS COLL and non-collapsing variants of FSGS are described in human immunodeficiency virus (HIV)-associated kidney disease. This study examined the range and relationships of Columbia-type segmental sclerosing lesions in biopsies from patients with HIV infection. We identified 47 renal biopsies from 46 patients with HIV infection obtained over an 8-year period. Twenty-seven biopsies from 26 patients had FSGS. Sixteen biopsies had FSGS COLL (59.3%), 3 had CELL (11.1%), 5 had NOS (18.5%), 2 had PH (7.4%), and 1 had GTL (3.7%) by the Columbia classification. Biopsies had more than one type of Columbia FSGS lesion in 63% and one type in 37%. Single types of FSGS lesions were identified in eight of eight biopsies with ≤10 glomeruli. Combinations of lesions were observed in 17 of 19 (89.5%) with >10 glomeruli, and the coincidence of COLL, CELL, and NOS lesions was not random. NOS, COLL, and CELL morphologic lesions of FSGS frequently coexist in kidney biopsies from HIV+ patients. Combined patterns of FSGS suggest that lesions identified by Columbia criteria may be part of a spectrum of responses to injury in the setting of HIV infection.