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Collapsing glomerulopathy in renal allograft biopsies: A study of nine cases
R Gupta1, A Sharma, S K Agarwal
1Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
Insights
Collapsing glomerulopathy (CG) is a rare kidney transplant complication. This study highlights CG as a significant cause of graft dysfunction and potential allograft failure in male recipients.
Area of Science:
- Nephrology
- Transplantation Medicine
- Pathology
Background:
- Collapsing glomerulopathy (CG) is a distinct pattern of podocyte injury.
- The clinical impact of CG in renal allografts is poorly understood due to limited data.
Purpose of the Study:
- To investigate the occurrence and clinical significance of collapsing glomerulopathy in renal allograft biopsies.
- To analyze the outcomes of kidney transplant recipients diagnosed with CG.
Main Methods:
- Retrospective identification of nine CG cases in allograft biopsies over two years.
- Collection of detailed clinical data, including follow-up information.
- Histopathological analysis of renal allograft biopsies.
Main Results:
- All nine patients were male, with a mean age of 32.4 years at diagnosis.
- CG occurred at a median of 52 months post-transplantation and presented with severe proteinuria and graft dysfunction.
- At a mean 6-month follow-up, four patients experienced graft failure, while four had functioning grafts.
Conclusions:
- Collapsing glomerulopathy is a rare but significant cause of renal allograft dysfunction.
- CG can lead to allograft failure, emphasizing the need for awareness and further research.
Abstract:
Collapsing glomerulopathy (CG) is considered to be a distinct clinicopathologic pattern of proliferative podocyte injury. The clinical significance of CG in renal allograft biopsies is yet not clear due to the scant data on the occurrence of CG in renal transplant recipients. We identified nine cases of CG in allograft biopsies over a period of 2 years. Detailed clinical information, including follow-up data, was collected and histopathological analysis performed. All the nine patients were males with a mean age at diagnosis of 32.4±11.2 years. The median posttransplantation duration at diagnosis of CG as 52 (range 12-98) months. All the patients presented with severe proteinuria and graft dysfunction. Histological analysis showed a median number of 8 glomeruli. The collapse of the glomerular tuft with visceral epithelial cell hyperplasia involved median of 2 glomeruli (range 1-4). At the last follow-up (mean duration 6 months), four patients had graft failure (return to dialysis) while four had functioning grafts. One patient was lost to follow-up. This series emphasizes the importance of this rare glomerular pathology as an important cause of graft dysfunction that may lead to allograft failure.
