Collapsing glomerulopathy is common in the setting of thrombotic microangiopathy of the native kidney

Abstract

Thrombotic microangiopathy (TMA) is a poorly recognized cause of collapsing glomerulopathy. The frequency and significance of collapsing glomerulopathy associated with renal TMA have not been specifically studied in native kidney biopsy specimens. Here we retrospectively documented clinicopathologic features of 53 patients with histologically proven TMA in the native kidney, with special emphasis on changes due to focal segmental glomerulosclerosis (FSGS). Histological TMA was related to hypertensive nephropathy in 21 patients, genetic complement abnormalities in 9, drugs in 7, and to other causes in 16 patients. Almost half (26 patients) presented with arteriolar, 6 with glomerular, and 21 with mixed TMA. Using the Columbia classification system for the 53 patients with histological TMA, 33 had concurrent FSGS lesions with collapsing glomerulopathy the dominant variant in 19 patients (58% of the FSGS cases), not otherwise specified in 9 patients, cellular in 3, and perihilar or tip lesions in 1 patient each. The presence of FSGS was associated with a poor renal prognosis, with no prognostic difference between collapsing glomerulopathy and other FSGS variants. Thus, collapsing glomerulopathy is frequently found in native kidney biopsies with TMA, suggesting that endothelial injury may play an important role in the pathophysiology of FSGS.

Collapsing Lesions and Focal Segmental Glomerulosclerosis in Pregnancy: A Report of 3 Cases

“…The incidence of collapsing FSGS in pregnancy is not known; we were able to find only 2 such reports, with 2 other reports (4 cases) in which collapsing lesions were superimposed on thrombotic microangiopathy (TMA). [28][29][30][31] The first 2 cases were reported in the first trimester of pregnancy (6 and 8 weeks' gestation). In the first case, systemic lupus erythematosus was present, and in the second, a viral infection and genetic predisposition coexisted.…”

“…28,29 In the 4 additional cases, collapsing glomerulosclerosis was associated with TMA; these patients developed acute kidney injury in the postpartum period. 30,31 The association with TMA [31][32][33] is intriguing. TMA is frequently found in preeclampsia, and some experts consider glomerular endotheliosis a specific variant of TMA.…”

Opana-induced thrombotic microangiopathy masquerading as thrombotic thrombocytopenic purpura

“…However, the labs (no serum cryoglobulins, low HCV viral load 192 000 IU/mL) and renal biopsy were not consistent with these diagnoses. Instead, the renal biopsy revealed collapsing glomerulopathy, which is commonly found in the setting of thrombotic microangiopathy and can rapidly progress to end-stage renal disease [6]. …”

Collapsing glomerulopathy: a 30-year perspective and single, large center experience

“…Although primarily reported in native kidneys, collapsing lesions can be seen in thrombotic microangiopathy (TMA) and other ischemic conditions in the allograft, and often occur in glomeruli with significant microangiopathic injury (Figure 1Q) [42–44]. In this setting, there should be a high threshold for the diagnosis of CGP.…”

“…The recent study by Buob et al . addressed the association from the endothelial injury point of view, bringing this mechanism into the pathogenesis of CGP [42]. …”