Kidney Week

Abstract: SA-PO0764

Preeclampsia as a Trigger for Collapsing Glomerulopathy in a Young Female Patient with Systemic Lupus Erythematosus

Session Information

• Glomerular Diseases: Lupus Nephritis, Monoclonal Gammopathy-Related Disease, and Transplantation
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Siddiqi, Mahwash, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States

Mahwash Siddiqi, MD

• Tahir, Maria, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States

Maria Tahir, MD

• Raza, Muhammad, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States

Muhammad Raza, MD

• Kaur, Gurwant, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States

Gurwant Kaur, MD, FASN

• Karasinski, Amanda A., Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States

Amanda A. Karasinski, MD

• Farooq, Umar, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States

Umar Farooq, MD, MS, MBA, FASN

• Miller, Ronald P., Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States

Ronald P. Miller, MD

• Ghahramani, Nasrollah, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States

Nasrollah Ghahramani, MD, FASN

• Verma, Navin, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States

Navin Verma, MD

Group or Team Name

• Division of Nephrology

Introduction

Preeclampsia is associated with glomerular endotheliosis, thrombotic microangiopathy, and anti-angiogenic dysregulation. Collapsing glomerulopathy, though rare in this context, can be triggered by the severe podocyte injury mediated by excess sFlt-1, which sequesters VEGF (vascular endothelial growth factor) and disrupts glomerular homeostasis. We report a case of preeclampsia-associated collapsing glomerulopathy in a young female with systemic lupus erythematosus, highlighting the critical importance of obstetric history in the evaluation of nephrotic syndrome

Case Description

A 21-year-old female with SLE controlled on prednisone, mycophenolate mofetil, and hydroxychloroquine, with a history of preeclampsia 8 months before presentation, was seen for bilateral lower extremity edema, fatigue, and acute kidney injury requiring dialysis. Labs revealed creatinine 6.0 mg/dL (baseline 0.9 one year prior), UPCR (Urine protein-to-creatinine ratio) 5.43 g/g, hypoalbuminemia, and hypertension. Serologies showed ANA titer 1:2560 with negative anti-dsDNA, normal complements, and negative hepatitis and HIV panels. Renal biopsy revealed focal collapsing glomerulopathy, with background class II lupus nephritis and with full-house immunofluorescence. She was treated with pulse steroids, and renal function improved in a few days without any need for dialysis.

Discussion

This case illustrates the dual pathological interplay between preeclampsia and glomerular disease. Preeclampsia can induce de novo glomerular injury, while underlying nephropathy independently increases preeclampsia risk. The anti-angiogenic milieu of preeclampsia, marked by excess sFlt-1 suppressing VEGF, can precipitate severe podocyte injury and collapsing lesions, analogous to mechanisms seen in HIV-associated nephropathy. In this patient, APOL1 high-risk genotypes prevalent in individuals of African descent may have further amplified susceptibility to collapsing glomerulopathy. This case underscores how an incomplete obstetric history can misdirect the diagnostic workup.