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Kidney Week

Abstract: TH-PO715

Collapsing Glomerulopathy: A Case Series

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Nnss, Harsha, Dr Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation, Vijayawada, Andhra Pradesh, India
  • Bandi, Varun Kumar, Dr Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation, Vijayawada, Andhra Pradesh, India
  • Chaganti, Sindhu, Dr Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation, Vijayawada, Andhra Pradesh, India
Introduction

Collapsing glomerulopathy (CG) is a rare variant of FSGS and is associated with rapid progression to ESRD. We present a series of three cases of CG.

Case Description

Case 1: A 32-year woman presented with acute pulmonary edema. She had tachycardia, stage II hypertension, and diffuse lung crepitations. On evaluation, she had global hypokinesia of left ventricle with ejection fraction of 25%, acute kidney injury (creatinine -3.6mg/dl) with a small right kidney (6.5cm). Her sputum culture grew multidrug-resistant Klebsiella pneumoniae. She was treated with Polymyxin B, diuretics, and three anti-hypertensives. There was no evidence of renal artery stenosis on doppler. Left renal biopsy was done, which showed collapsing glomerulopathy with IgA nephropathy, and was started on oral steroids. At 3 months, her BP is controlled on one drug, creatinine is 2.8mg/dl.

Case 2: A 55-yr male presented with nephrotic syndrome. He had well-controlled diabetes and hypertensive. His creatinine worsened from 3.5 to 6.4mg/dl. Renal biopsy showed collapsing glomerulopathy with diabetic nephropathy, RPS class 3. He was treated with oral steroids but had no recovery and is dialysis dependent.

Case 3: A 46-year-old man presented with umbilical hernia. He was found to have nephrotic syndrome, right renal mass, and renal failure. A well-defined lobulated heterogeneously enhancing lesion with cystic areas was seen arising from the lower pole of the right kidney, suggestive of renal cell carcinoma. Left renal biopsy showed collapsing glomerulopathy with diabetic nephropathy, RPS class III. He underwent right partial nephrectomy, which showed renal cell carcinoma–Clear cell variant. At 3 months, he has no edema, normal serum Albumin, and creatinine.

Discussion

We present a series of collapsing GN, with varying outcomes. Case 1 had partial recovery, case 2 had rapid progression, and case 3 had complete recovery. The etiology could be probably uncontrolled hypertension and IgA nephropathy in case 1, Case 2 was idiopathic, and Case 3 was malignancy related.