Abstract: FR-PO0940
Long-Term Follow-Up of Two Patients with Successfully Treated Idiopathic Collapsing FSGS with Methylprednisolone Pulse
Session Information
- Glomerular Case Reports: Lupus, FSGS, Complement, and More
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Author
- Doddi, Prabhakar, Kidney Health Clinic, Visakhapatnam, India
Introduction
Focal segmental glomerulosclerosis (FSGS) is one of the common causes of nephrotic syndrome in adults. Collapsing glomerulopathy (CG) is a histopathological variant of FSGS with poor response to treatment and prognosis. Here we present two cases with biopsy proven CG who achieved complete remission(CR) with methylprednisolone pulse(MP) and their long term follow up
Case Description
Case 1- A 30-year-old male visited in May 2018 with anasarca, shortness of breath and oliguria. His medical and family history were not significant. On examination his blood pressure was 150/90 mm of Hg and basal pulmonary rales on both sides noted. Laboratory investigations showed in the table. Kidney biopsy was done after 4 sessions of hemodialysis which showed 25 glomeruli in light microscopy(LM) of which 3 glomeruli showed segmental collapse. Evidence of acute tubular necrosis (ATN) is present. Interstitial fibrosis and tubular atrophy (IFTA) was negligible. Immunofluorescence (IF) didn’t show any immune deposits. He was diagnosed with idiopathic CG with AKI and treated with MP of 1gm/day for 3 days followed by 1 mg/kg of prednisolone for one month, later tapered and stopped after 12 weeks. He achieved CR (table). He maintained remission during 7 years of follow up. Case 2- A 36-year-old male presented to in February 2022 with pedal oedema. His medical and family history, vitals and systemic examination were not contributory. Laboratory parameters showed in the table. Kidney biopsy showed 10 glomeruli in LM of which one showed segmental collapse. IFTA was < 5%. Mild ATN was present. He was followed for 3 years.His diagnosis and treatment response are similar to case1.
Discussion
Treatment response is very poor for CG. With only oral steroids the remission rate is 0-20%. Remission rate with cyclophosphamide, calcineurin inhibitors is less than 50%. Renal survival time for CG patients is around 13 months. We are the first to use upfront MP pulse therapy in CG with AKI which resulted in achievement and maintainace of CR during long term follow up.
| case 1 | case 2 | |||||
| Laboratory parameters | At presentation | At 12 weeks of treatment | At 84 months of follow up | At presentation | At 12 weeks of treatment | At 36 months of follow up |
| Serum creatinine (mg/dl) | 8.1 | 1.0 | 0.9 | 3.5 | 1.2 | 1.1 |
| Serum albumin (gm/dl) | 1.6 | 3.4 | 3.8 | 2.8 | 3.5 | 3.6 |
| Urine alumin | 4+ | Nil | Nil | 3+ | Nil | Nil |
| 24 hour urine protein (mg/day) | NA | 250 | 180 | 4000 | 350 | 59 |
| HBsAg, Anti HCV, HIV -I/II, Anti nuclear antibodies | negative | - | - | - | - | - |