ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO1600

Collapsing Glomerulopathy Can Worsen Prognosis in Lupus Nephritis

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Yi, Jia, University of North Carolina System, Chapel Hill, North Carolina, United States
  • Derebail, Vimal K., University of North Carolina System, Chapel Hill, North Carolina, United States
  • Hogan, Susan L., University of North Carolina System, Chapel Hill, North Carolina, United States
  • Poulton, Caroline J., University of North Carolina System, Chapel Hill, North Carolina, United States
  • Blazek, Lauren N., University of North Carolina System, Chapel Hill, North Carolina, United States
  • Jain, Koyal, University of North Carolina System, Chapel Hill, North Carolina, United States
Background

Collapsing glomerulopathy (CG) conveys a poor renal prognosis and is characterized by podocytopathy with segmental or global collapse of the capillary walls. While it can be idiopathic, it is often seen in association with other viral, drug, and autoimmune conditions including lupus nephritis (LN). This retrospective study describes features and clinical outcomes of 16 patients with SLE and biopsy proven CG.

Methods

Using our Glomerular Disease Collaborative Network registry, we performed retrospective chart review on patients with systemic lupus erythematosus and CG on kidney biopsy with or without an LN lesion from 2000 - 2021. For patients with multiple biopsies, the first biopsy with GC was identified as the incident biopsy. We defined poor renal outcome as reaching a renal endpoint of serum creatinine doubling, chronic dialysis initiation, or renal transplantation. Patients were characterized by baseline demographics, laboratory results, serologies, interstitial fibrosis, and medications.

Results

We identified 16 patients with mean age of 33 years at incident biopsy. Most were female (87.5%) and black (87.5%). Mean serum creatinine (Sr Cr) was 3.1mg/dL and mean proteinuria by 24-hour urine collection or spot urine protein:creatinine ratio was 7.12g. Excluding 2 patients with limited follow-up, 11 of 14 (78.6%) patients had poor renal outcomes. These patients were similar in age (mean 33 years) and were also majority female (90.1%) and black (90.1%). In this group, mean Sr Cr was 3.53mg/dL and proteinuria was 3.69g. This group had significant interstitial fibrosis and tubular atrophy (IFTA) with 71.4% moderate and 28.6% severe IFTA. They reached renal endpoint in 4.5 years (average). Of 3 patients who did not have a renal end point, mean Sr Cr was 1.83 mg/dL with less IFTA noted on biopsy. Treatment options varied with most receiving mycophenolate or cyclophosphamide.

Conclusion

This descriptive project confirmed that CG was associated with poor renal prognosis in LN; the majority of the patients required dialysis, proceeded to transplantation, or had doubling of serum creatinine during follow up. Despite treatment with standard of care agents, outcomes remained poor. Patients who had worse Sr Cr at presentation or severe IFTA had worse outcomes.