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. 2020 Sep-Oct;30(5):321-325.
doi: 10.4103/ijn.IJN_65_19. Epub 2020 Mar 28.

Post Renal Transplant Collapsing Glomerulopathy is Associated with Poor Outcomes

B Karthikeyan  1 , M Edwin Fernando  1 , N D Srinivasaprasad  1 , S Sujit  1 , K Thirumal Valavan  1 , Anila A Kurien  1
Affiliations

Post Renal Transplant Collapsing Glomerulopathy is Associated with Poor Outcomes

B Karthikeyan et al. Indian J Nephrol. 2020 Sep-Oct.

Abstract

Introduction: Collapsing glomerulopathy (CG) is a distinct morphologic pattern of proliferative renal parenchymal injury. It differ from focal segmental glomerulosclerosis (FSGS) by clinicopathologic pattern and its adverse outcome. The clinical significance of CG in renal allograft biopsies is not yet clear due to scant data and less occurrence of CG in renal transplant recipients. We conducted this single-center retrospective study to evaluate the prevalence, clinicopathological features, and outcome of post renal transplant CG.

Subjects and methods: We studied 127 renal allograft biopsies performed over a period of 45 months (Jan 2015-Oct 2018). A diagnosis of CG was made if at least one glomerulus demonstrated global or segmental collapse of the glomerular capillary walls, associated marked hyperplasia, and hypertrophy of the overlying visceral epithelial cells. We analyzed clinical, biochemical, and pathological characteristics and its impact on renal allograft outcome. Statistical analysis was performed and continuous variables were expressed as means ± standard deviation (SD) or medians (interquartile range and noncontinuous data were expressed in percentage and numerical values.

Results: The prevalence of CG was 5.3% (7/127) of allograft biopsies. Out of the seven patients, six patients had undergone live donor transplant and one patient had undergone deceased donor renal transplant. The native kidney disease was unknown in these patients except one (IgA nephropathy). The median duration of diagnosis for CG was 17 months after transplantation (range 5-132months). Presenting symptoms were pedal edema and hypertension in 71.4% (5) patients each. All patients had proteinuria of more than 1 gm and renal allograft dysfunction and median serum creatinine of 3.05 mg/dl (1.5-4.8 mg/dl). All patients received standard triple immunosuppression. Over a period of 2-20 months, 57.14% (4) patients developed a graft failure and 43% (3) of the other patients had functioning grafts with serum creatinine of 1.5-4.2 mg/dl.

Conclusions: CG presents with moderate to severe proteinuria and may lead to rapid graft dysfunction and subsequent graft failure in most of the patients.

Keywords: CG-collapsing glomerulopathy; CNI-calcineurin inhibitors; GD-graft dysfunction; GF-graft failure.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Renal biopsy H and E stain: Renal allograft biopsy showing collapse of the glomerular tuft
Figure 2
Figure 2
Renal biopsy pas stain: Renal allograft biopsy showing collapse of the glomerular tuft with tubular injury
Figure 3
Figure 3
Renal biopsy pas-silver stain: Renal allograft biopsy showing collapse of the glomerular tuft
Figure 4
Figure 4
Trend of Serum creatinine among patients
See this image and copyright information in PMC

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