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Collapsing Glomerulopathy in a Patient With Malaria and Multiple Myeloma: A Case Report
Moritz Harenberg1, Kerstin Amann2, Daniel Zickler1
1Department of Nephrology and Medical Intensive Care, St. Joseph Krankenhaus, Berlin, Germany.
Abstract:
Collapsing glomerulopathy is a severe form of focal segmental glomerulosclerosis (FSGS) that can occur as a primary or secondary condition, often in the context of infections such as HIV. Multiple myeloma can cause kidney injury through mechanisms such as cast nephropathy, while malaria-associated kidney injury is most often due to acute tubular necrosis. We present the case of a 47-year-old male of African descent with well-controlled HIV infection who became critically ill with severe AKI requiring intensive care and renal replacement therapy. A blood smear confirmed Plasmodium falciparum infection, and the clinical course was further complicated by a previously undiagnosed multiple myeloma. Given the multiple potential etiologies, a kidney biopsy was performed, which ruled out myeloma-associated kidney injury and revealed collapsing glomerulopathy. The temporal association with the malaria infection, together with the well-controlled HIV status, pointed to malaria-associated collapsing glomerulopathy as the most likely diagnosis. This case highlights the diagnostic challenges of AKI in critically ill patients with overlapping comorbidities and underscores the value of kidney biopsy in guiding the differential diagnosis.
Insights
Malaria infection can cause collapsing glomerulopathy, a severe kidney disease, especially in patients with HIV and multiple myeloma. Kidney biopsy is crucial for diagnosing this rare condition.
Area of Science:
- Nephrology
- Infectious Diseases
- Hematology
Background:
- Collapsing glomerulopathy is a severe form of focal segmental glomerulosclerosis (FSGS).
- Kidney injury can arise from HIV, multiple myeloma, and malaria.
- Distinguishing causes of acute kidney injury (AKI) in complex cases is challenging.
Purpose of the Study:
- To present a case of malaria-associated collapsing glomerulopathy in a patient with HIV and multiple myeloma.
- To highlight diagnostic challenges in critically ill patients with overlapping comorbidities.
- To emphasize the utility of kidney biopsy in determining the etiology of AKI.
Main Methods:
- Clinical case presentation of a 47-year-old male with severe AKI.
- Diagnostic workup included blood smear for malaria and kidney biopsy.
- Ruled out multiple myeloma-related kidney injury.
Main Results:
- Patient diagnosed with Plasmodium falciparum malaria and collapsing glomerulopathy.
- Kidney biopsy confirmed collapsing glomerulopathy, excluding myeloma-associated nephropathy.
- Malaria was identified as the likely cause of collapsing glomerulopathy.
Conclusions:
- Malaria can precipitate collapsing glomerulopathy, even in patients with HIV.
- Kidney biopsy is essential for accurate diagnosis of AKI in multifactorial cases.
- This case underscores the importance of considering infectious etiologies in AKI.
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