Many genetic causes of focal segmental glomerulosclerosis (FSGS) have been described. A paradox is that the science in the
molecular biology, which generally appears of high quality, is not mirrored by a similarly critical analysis of the renal pathology.
FSGS has been applied to such a wide range of conditions that it can reasonably be said to have no useful meaning. Attempts to
refine the term have been largely ignored. Study of 252 papers on genetic causes of FSGS found various clinical features. Many
papers took the reported diagnosis without question. Few papers reported a pathological review, almost half reported FSGS and
up to six other conditions caused by any particular gene, some reported FSGS with recognisable glomerular disorders, over 80%
did not apply the Columbia classification, and in nearly all with photomicrographs, the images were not useful for refinement of
FSGS. Some workers commented on a lack of genotype-phenotype correlation. One reason is a disregard of the principle that
scientific investigation requires an unambiguous definition of the condition studied, to allow others to replicate or refute the
findings. Genetic studies of FSGS should use a similarly rigorous approach to renal pathology to that used in molecular biology