Abstract: FR-PO741
Collapsing FSGS: Vascular Injury as a Cause of Secondary Collapsing Glomerulopathy?
Session Information
- Clinical/Diagnostic Renal Pathology and Lab Medicine - II
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Glomerular
- 1004 Clinical/Diagnostic Renal Pathology and Lab Medicine
Authors
- Gougeon, Francois, UNC-Chapel Hill Nephropathology, Chapel Hill, North Carolina, United States
- Singh, Harsharan Kaur, University of North Carolina School of Medicine , Chapel Hill, North Carolina, United States
- Jennette, J. Charles, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Nickeleit, Volker, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
Background
Collapsing glomerulopathy (CG) has been associated with various diseases such as infections, diabetes mellitus or auto-immune diseases. In renal allografts CG has occasionally been linked to perfusion abnormalities. At present a systematic review of CG and concurrent other renal diseases is lacking
Methods
We searched our database for a biopsy diagnosis of CG in native and transplant kidneys between 01/2011 and 01/2016. Among 7641 cases 4.4% (322) showed CG in an initial index biopsy. Tip variant FSGS 51/7641 (0.7%) served as one control cohort. Cases were grouped as: 1) “pure”: no other significant kidney disease, 2) presumptive “secondary”: with concurrent other significant renal diseases
Results
CG was more often secondary than the tip-variant (152/322, 47% vs. 14/51, 28%; p<0.01; table 1). In the study set three disease categories were significantly more often diagnosed in secondary CG: severe arterionephrosclerosis (AS; 25%), membranous glomerulopathy (MGN, 15%) and thrombotic microangiopathies (TMA, 9%; all p<0.01). In comparison secondary tip variant FSGS showed tightest associations with MGN and no association with TMA. In transplants, 21/30 (70%) of CG cases were classified as secondary: 7/21 had prominent vascular sclerosis and 4/21 antibody mediated rejection with microvascular injury
Conclusion
In conclusion: CG but not tip-variant FSGS is commonly associated with concurrent renal diseases. Secondary CG is significantly linked to vascular injury (AS, TMA, rejection with capillaritis). These findings further understanding of CG and pending future studies can streamline diagnostic decision making
| CG | Tip lesion | Total cohort | |
| Total Total "pure Total "secondary" | 322 | 51 | 7319 |
| 170 (52.8%) | 37 (72.5%) | N/A | |
| 152 (47.2%) | 14 (27.5%) p=<0.01 | N/A | |
| Associations in "secondary" cohort | |||
| Severe arteriosclerosis | 38/152 (25.0%) | 2/14 (14.3%) | 757 (10.3%) p<0.01 |
| Membranous glomerulopathy | 22/152 (14.5%) | 5/14 (35.7%) p<0.05 | 623 (8.5%) p<0.01 |
| Lupus nephropathy | 20/152 (13.2%) | 1/14 (7.1%) | 663 (9.1%) |
| Diabetic nephropathy | 20/152 (13.2%) | 1/14 (7.1%) | 951 (13.0%) |
| Thrombotic microangiopathy | 14/152 (9.2%) | 0 | 187 (2.6%) p<0.01 |
| Combined severe arteriosclerosis and diabetic nephropathy | 12/152 (7.9%) | 0 | 372 (5.1%) |
| IgA nephropathy (proliferative) | 4/152 (2.6%) | 0 | 320 (4.4%) |
| ANCA-associated glomerulonephritis | 3/152 (2.0%) | 0 | 406 (5.5%) |
| Other | 19/152 (12.5 %) | 5/14 (35.7%) | N/A |
Table 1: Total biopsy cohort and tip lesion compared to secondary CG cases (natives). All statistics refer to comparison with the CG cohort.