Nephropathology Since 2006
   
Case 146
Diagnosis
 
     
Versión en Español

Go back to clinical information and images

Diagnosis: Collapsing Glomerulopathy

Collapsing glomerulopathyu (CG) is a morphologic lesion representing a common endpoint from multiple etiologies. It is a podocytopathy that is often secondary to APOL1 risk variants but has also been associated with infection, drugs, ischemia, hematologic neoplasia and autoimmune disease. Morphological features of CGP are time-tested and well-recognized today. However, there are several confounding morphologies that may provide diagnostic difficulty. The discovery of APOL1 risk variants changed the way we understand and classify CGP and provide, in part, a unifying etiology for some of the underlying associations, leading to a more pathogenesis-based approach to this multifaceted diagnosis (Nicholas Cossey L, et al. Collapsing glomerulopathy: a 30-year perspective and single, large center experience. Clin Kidney J. 2017;10(4):443-449. [PubMed link]).

The term “collapsing glomerulopathy” was used for the first time in 1986, and it was assumed to be a variant of FSGS. However, CG is frequently an aggressive disease, with massive proteinuria and rapid progression to chronic renal disease. The notoriously more aggressive outcome in CG that in the other variants of FSGS, and the phenotypic features of podocytes indicating a different pathogenesis, have led some authors to considere that CG is not a variant of FSGS, but another glomerular alteration.

See the chapter: Focal Segmental Glomerulosclerosis of our Tutorial.

 

Go back to clinical information and images

References

  • Kanodia KV, Vanikar AV, Nigam LK, Patel RD, Suthar KS, Patel HV, Trivedi HL. Collapsing Glomerulopathy- A Troublemaker for the Renal Allograft: Lessons Learnt. Indian J Nephrol. 2017;27(5):342-346. [PubMed link]
  • Nicholas Cossey L, Larsen CP, Liapis H. Collapsing glomerulopathy: a 30-year perspective and single, large center experience. Clin Kidney J. 2017;10(4):443-449. [PubMed link]
  • Li SY, Park J, Qiu C, Han SH, Palmer MB, Arany Z, Susztak K. Increasing the level of peroxisome proliferator-activated receptor γ coactivator-1α in podocytes results in collapsing glomerulopathy. JCI Insight. 2017;2(14). [PubMed link]
  • Shah PB, Cooper JE, Lucia MS, Boils C, Larsen CP, Wiseman AC. APOL1 Polymorphisms in a Deceased Donor and Early Presentation of Collapsing Glomerulopathy and Focal Segmental Glomerulosclerosis in Two Recipients. Am J Transplant. 2016;16(6):1923-1927. [PubMed link]
  • McNicholas BA, Nelson PJ. Immunity unmasks APOL1 in collapsing glomerulopathy. Kidney Int. 2015;87(2):270-2. [PubMed link]

[Top]

Go back to clinical information and images