Collapsing glomerulopathy associated with pulmonary tuberculosis

Abstract

Collapsing glomerulopathy (CG) usually presents with reduced glomerular filtration rate, heavy proteinuria and has unfavorable prognosis. Numerous associations with CG are found. We encountered a case of CG associated with pulmonary tuberculosis presenting with proteinuria and dialysis-requiring severe renal failure. Our patient made partial recovery of his renal function and became dialysis-independent after antituberculous therapy and oral steroids. Long-term follow-up is needed to assess the progression of the disease.

Sudden Collapse in the First Trimester: Report of Hyperacute Renal Failure Secondary to Collapsing Glomerulopathy as the Initial Presentation of Lupus

“…CG is found in patients with SLE who present with acutely progressive renal failure, and patients with CG have signs and symptoms of renal failure including proteinuria, which is often in the nephrotic range [ 7 ], as well as elevated creatinine and BUN, low glomerular filtration rate (GFR), and fluid overload that manifests as dyspnea, orthopnea, bibasilar rales, and bilateral lower extremity edema. Like the patient presented in this case, a large percentage of patients with CG progress to end-stage renal disease [ 6 ]. Although pre-eclampsia, eclampsia, and sepsis are the most common causes of pregnancy-related acute renal failure [ 10 ], CG secondary to untreated lupus nephritis in a pregnant patient is a rare cause of pregnancy-related acute renal failure.…”

“…The prognosis for CG is poor [ 4 - 6 ]. CG is classified as a variant of focal segmental glomerulosclerosis (FSGS) [ 6 ].…”

“…The prognosis for CG is poor [ 4 - 6 ]. CG is classified as a variant of focal segmental glomerulosclerosis (FSGS) [ 6 ]. The mortality of patients with SLE is three times higher than the general public [ 7 ].…”

“…Although newly recognized to be associated with SLE and other collagen vascular disease, CG is known to be associated with other autoimmune diseases, HIV, cytomegalovirus (CMV), tuberculosis, parvovirus B19, hepatitis C virus, and induced by medications (i.e., pamidronate, valproic acid, interferon-alpha, or bisphosphonates) [ 1 , 4 , 6 - 8 ]. CG is most commonly seen in African American women with a history of intravenous drug use [ 6 ]. Pregnancy is an additional risk factor for CG as pregnancy can predispose a patient with untreated lupus nephritis to develop hyperacute renal failure in the form of CG [ 9 ].…”

“…Renal biopsy is required to visualize the collapse of the glomeruli to confirm the diagnosis of CG. CG is diagnosed by inspecting renal tissue samples under light microscopy, which display pseudo-crescents from the collapse of glomerular capillaries with proliferation and swelling of the overlying podocytes [ 6 ]. Under electron microscopy, CG appears as a collapsed glomerular basement membrane with foot process effacement and hypertrophy of the overlying podocytes [ 6 ].…”