Role of podocytes in focal sclerosis: defining the point of no return.

P odocyte dysfunction is linked to progressive glomerular filtration barrier failure and glomerulosclerosis. A detailed sequence of structural alterations is now used to define three general modes of podocyte damage, highlighting degenerative, inflammatory, or dysregulative pathways to glomerulosclerosis (1). In this issue of JASN, three reports offer novel insights into the causal relationship between podocyte damage and glomerulosclerosis and define specific markers that identify the “point of no return” in glomerular filtration barrier failure. The authors have focused on the following questions: