Collapsing glomerulopathy- A troublemaker for the renal allograft: Lessons learnt

Abstract

Collapsing glomerulopathy (CG) is a well-recognized distinct morphological pattern of proliferative parenchymal injury leading to rapid graft failure. We conducted a single-center retrospective study to evaluate the prevalence, clinicopathological features, and prognosis of CG in renal transplant recepient. We analyzed 2518 renal allograft biopsies performed from 2007 to 2015 and correlated their clinicopathological features. The prevalence of CG was 0.83% (21 out of 2518) of allograft biopsies with a higher prevalence of 1.4% during the period from 2012 to 2015. Out of 21 patients, 18 (85.71%) patients had undergone live donor and 3 (14.28%) patients had undergone deceased donor renal transplant. Hypertension was observed in 3 (14.28%) patients. The mean duration of diagnosis for CG was 1.85 ± 1.91 years. Urinalysis revealed microhematuria in 5 (23.8%) patients. The mean 24 h urinary protein excretion was 4.77 ± 5.3 g and serum creatinine was 2.12 ± 1.5 mg/dl. The predominant native kidney diseases in recipients were chronic glomerulonephritis of unknown etiology in 12 (57.14%) patients and hypertensive nephropathy in 3 (14.28%) patients. CG was associated with rejection in 9 (42.85%), calcineurin-inhibitor toxicity in 2 (9.5%), and BK virus nephropathy in 1 patient. All patients received standard triple immunosuppression. Eleven (52.38%) patients developed graft failure over a mean period of 2.2 ± 1.7 years and 6 (28.57%) patients recovered with stable graft function. CG can coexist with viral infection, drug toxicity, rejection, microvascular injury, etc. CG usually presents with moderate to severe proteinuria and may lead to rapid graft dysfunction and subsequent graft failure in most of the patients.

Post renal transplant collapsing glomerulopathy is associated with poor outcomes

“…reported 11 (52.38%) out of 21 patients in IKDRC study developed graft failure over a period of 2.2 ± 1.7 years. [ 14 ] Similarly in our study, graft failure was 57.14% [ Figure 4 ]. There is no recommendation for therapy in allograft CG, but plasmapheresis and high-dose steroids were tried, especially when CG was associated with rejection.…”

“…[ 10 11 12 ] In the present study, the overall prevalence of CG was 5.5%, which is higher compared to other studies. One of the studies reported a similar frequency of 3.2%,[ 10 ] other studies reported an overall prevalence is 0.6–0.83%,[ 13 14 ] which shows an increasing awareness in recent years. All the patients had proteinuria more than 1 gm (1.2–5.9 g/d), three of them had the nephrotic range and the serum creatinine was 1.5–4.8 mg/dl and other reported studies show similar results [ Table 3 ].…”

“…All the patients had proteinuria more than 1 gm (1.2–5.9 g/d), three of them had the nephrotic range and the serum creatinine was 1.5–4.8 mg/dl and other reported studies show similar results [ Table 3 ]. [ 10 11 12 13 14 ]…”

“…The predominant native kidney disease was chronic kidney disease (CKD) of unknown etiology (57.14%), leading to end-stage renal disease, so we could not ascertain whether our cases were denovo or recurrent. [ 14 ]…”