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Collapsing glomerulopathy in older adults.

Benjamin Kukull1, Rupali S Avasare2, Kelly D Smith3

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Collapsing glomerulopathy in older adults often shows chronic kidney injury and does not improve with immunosuppression. This condition, unlike in younger patients, rarely stems from viral infections.

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Area of Science:

  • Nephrology
  • Pathology
  • Geriatrics

Background:

  • Collapsing glomerulopathy (CG) is a severe form of focal segmental glomerulosclerosis with a poor prognosis.
  • CG is associated with various triggers including viral infections, drugs, and genetic factors.
  • Limited data exists on CG specifically in the elderly population.

Purpose of the Study:

  • To characterize the clinical and morphologic features of collapsing glomerulopathy in patients aged 65 and older.
  • To evaluate the outcomes and treatment responses in this specific demographic.

Main Methods:

  • Retrospective review of renal biopsies and clinical data from 41 patients aged 65+ diagnosed with CG across three institutions.
  • Analysis of patient demographics, comorbidities, biopsy findings, treatments, and clinical outcomes.

Main Results:

  • Most patients (91%) presented with nephrotic range proteinuria and renal insufficiency (median creatinine 2.5 mg/dL).
  • Hypertension was common (88%); viral infections were infrequent triggers (5%).
  • Biopsies showed significant global glomerulosclerosis (median 40%) and chronic changes in vasculature and tubulointerstitium (approx. 60%).

Conclusions:

  • Collapsing glomerulopathy in older adults is typically linked to significant underlying chronic kidney damage rather than acute triggers like viral infections.
  • Immunosuppressive therapy showed no significant benefit for overall or renal survival and was associated with adverse events in some patients.
  • The findings suggest a need for tailored management strategies for CG in the elderly, focusing on managing comorbidities and avoiding potentially harmful treatments.