Collapsing glomerulopathy in renal allograft biopsies: A study of nine cases

Abstract

Collapsing glomerulopathy (CG) is considered to be a distinct clinicopathologic pattern of proliferative podocyte injury. The clinical significance of CG in renal allograft biopsies is yet not clear due to the scant data on the occurrence of CG in renal transplant recipients. We identified nine cases of CG in allograft biopsies over a period of 2 years. Detailed clinical information, including follow-up data, was collected and histopathological analysis performed. All the nine patients were males with a mean age at diagnosis of 32.4±11.2 years. The median posttransplantation duration at diagnosis of CG as 52 (range 12–98) months. All the patients presented with severe proteinuria and graft dysfunction. Histological analysis showed a median number of 8 glomeruli. The collapse of the glomerular tuft with visceral epithelial cell hyperplasia involved median of 2 glomeruli (range 1–4). At the last follow-up (mean duration 6 months), four patients had graft failure (return to dialysis) while four had functioning grafts. One patient was lost to follow-up. This series emphasizes the importance of this rare glomerular pathology as an important cause of graft dysfunction that may lead to allograft failure.

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

“…Most of the studies have reported that patients with CG eventually develop graft failure over a variable time period. [ 9 10 11 ] We also have observed that 11 (52.38%) out of 21 patients in our study developed graft failure over a period of 2.2 ± 1.7 years.…”

“…[ 7 ] CG in renal allografts has been reported in literature in the form of few case reports and small studies [ Table 5 ]. [ 8 9 10 11 ] In the present study, the overall prevalence of CG in renal transplant was 0.83%. However, we report a higher prevalence of 1.4% in the last 4 years, which shows an increasing awareness of disease in recent years.…”

“…Other reports showed that CG in allograft can occur anytime from 6 to 98 months after transplantation. [ 9 10 11 12 ] The range of proteinuria in our study was 1.3–6.7 g/24 h and SCr was 1.4–4.6 mg/dl. Swaminathan et al .…”

“…[ 9 10 11 ] Plasmapheresis has been attempted to treat / de novo recurrent focal and segmental glomerulosclerosis with little benefit. [ 10 11 ] Thus, prognosis of CG remains dismal. Most of the studies have reported that patients with CG eventually develop graft failure over a variable time period.…”

Collapsing glomerulopathy, the Saudi Arabian scenario

“…Neoplastic conditions like hemophagocytosis syndrome and multiple myeloma, drugs like interferon-α and bisphosphonates (pamidronate) can also lead to CG 17-20. Collapsing glomerulopathy has also been reported as de novo disease post renal transplant 21,22. Occasional genetic/ familial forms have been reported 23.…”