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Diagnosis: Glomerular collapse associated with severe donor ischemic changes.

In addition to glomerular collapsing changes, there are severe acute tubular necrosis, and arterial and arteriolar changes of severe hypertension.

Collapsing glomerulopathy is defined by podocyte hipertrophy and proliferation, and ccapillary loop collapse. This is considered a glomerulopathy and has been associated to HIV, autoimmune diseases, drug exposure, infections, malignancies and genetic disorders. However recently have been described collapsing changes associated to ischemia.

In both patientes (receptors) there was not severe proteinuria and renal graft function was normal several weeks after.

Podocyte transdifferentiation, loss of mature podocyte phenotype, podocyte proliferation, and acquisition of a macrophage-like phenotype appear be important in pathogenesis. Together, these data suggest that acute glomerular ischemia may lead to glomerular collapse in kidney transplants. Recent evidence that hypoxia-inducible factor (HIF) upregulation in podocytes leads to their proliferation and dedifferentiation in HIVassociated nephropathy is striking, and this upregulation could have an important roll en ischemic collapsing lesions (Korgaonkar SN, et al. HIV-1 upregulates VEGF in podocytes. J Am Soc Nephrol. 2008 May;19(5):877-83 [PubMed link]).

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Bibliography

• Canaud G, Bruneval P, Noël LH, Correas JM, Audard V, Zafrani L, Rabant M, Timsit MO, Martinez F, Anglicheau D, Thervet E, Patey N, Legendre C, Zuber J. Glomerular collapse associated with subtotal renal infarction in kidney transplant recipients with multiple renal arteries. Am J Kidney Dis. 2010;55(3):558-65. [PubMed link]
• Nadasdy T, Allen C, Zand MS. Zonal distribution of glomerular collapse in renal allografts: possible role of vascular changes. Hum Pathol. 2002 Apr;33(4):437-41. [PubMed link]

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