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Abstract: SA-PO723

Parvovirus B19 and Collapsing Glomerulopathy in a Postpartum Female

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Khazoum, Elias S., Franciscan Health Inc, Mishawaka, Indiana, United States
  • Zaman, Azkaa, Franciscan Health Inc, Mishawaka, Indiana, United States
  • Elsayed, Norhan, Franciscan Health Inc, Mishawaka, Indiana, United States
  • Odelugo, Chetachi E., Franciscan Health Inc, Mishawaka, Indiana, United States
  • Hubeishy, Moudi, Franciscan Health Inc, Mishawaka, Indiana, United States
  • Azad, Shanaz, Franciscan Health Inc, Mishawaka, Indiana, United States
  • Sarguroh, Tauseef A., Franciscan Health Inc, Mishawaka, Indiana, United States
Introduction

Collapsing glomerulopathy (CG) is a variant of FSGS characterized by rapid onset and progression of renal failure. Interstitial fibrosis (IF), tubular atrophy (TA), entry level serum creatinine (SrCr) and degree of proteinuria have been used as predictors for progression.

Case Description

A 36-year-old African American female with a history of obesity reported gradual development of lower extremity edema following delivery of her second child. Her pregnancy was complicated by gestational diabetes and preeclampsia. At four months postpartum, she developed an upper respiratory infection followed by onset of exertional dyspnea, orthopnea, chest pain and worsening edema for which she presented to the hospital. Of note, she mentioned that her newborn was being treated for a rash on her face and scalp. Workup showed a SrCr of 1.0 mg/dL and a urine protein to creatinine ratio of 7.0 g/g. An echocardiogram revealed biventricular systolic dysfunction. Renal biopsy showed CG with moderate IF/TA and sclerosis of 24% of glomeruli. Serologies and HIV were negative, but parvovirus B19 (PvB19) IgM and IgG titers were elevated. Furosemide, losartan and spironolactone were started. Two weeks after discharge her repeat labs demonstrated SrCr of 1.0 mg/dL and proteinuria improved to 1.94 g/g.

Discussion

In one study, all CG patients with recovery of renal function had both IF and TA < 25% on biopsy. Another found IF > 20%, SrCr >2, and proteinuria of > 8 g/day to be strong indicators of progression. A previous case report of CG in a 36-year-old intrapartum female with acute PvB19 infection and little IF/TA on initial biopsy showed rapid progression to ESRD, though she carried two APOL1 risk alleles. Our patient’s preserved renal function and improved proteinuria on follow-up, despite risk factors of moderate IFTA on biopsy, may be related to a decreased genetic risk.